Hospital Waiting Lists: Motion [Private Members]

Deputy Billy Kelleher

I move:

That Dáil Éireann:

notes:

— that more than 660,000 people are on a hospital waiting list;

— that there are in excess of 100,000 outpatient appointments outstanding for over a year as of May 2017;

— the establishment, in January 2015, of maximum permissible waiting times for inpatient/day case treatment and outpatient appointments of 18 months by 30th June, 2015 and 15 months by the end of 2015;

— that these targets were not met and still have not been met;

— that 46,629 outpatients were on the waiting list for more than 18 months in April 2017; and

— that 5,770 patients were on the inpatient and day case waiting lists for more than 18 months in April 2017;

further notes:

— the very great distress and pain being suffered by people enduring long periods on hospital waiting lists;

— the fact that the long waiting times are further exacerbating the clinical conditions needing treatment thereby producing more pain and suffering; and

— that such long waits are not only intolerable and excruciating for the patients, they are also counterproductive and a waste of health service resources and lead to poorer clinical outcomes and increased mortality;

recognises:

— the deplorable and dangerous overcrowding that continues to be experienced in hospital emergency departments;

— the record number of patients waiting on trolleys, particularly the frail elderly, during the first four months of 2017;

— that such overcrowding results in further delays in scheduled hospital treatments and essential surgery, thereby further worsening the waiting lists; and

— the comments by the Director General of the Health Service Executive, HSE, that should the trend in presentations to emergency departments continue that all work will be emergency work and hospitals will be unable to accommodate elective work; and

calls on the Government and the HSE to:

— hold each hospital chief executive accountable for the open disclosure of accurate data on waiting lists in each hospital;

— make transparent to the public the monthly progress from each hospital on waiting list figures, giving specific detail on outpatient waiting lists, access to diagnostic waiting lists and elective surgery lists;

— ensure each hospital group present monthly updates on waiting list progress of each hospital in their region, making transparent the difference between those patients awaiting a clinical procedure or elective surgery or an appointment to be seen in an outpatient clinic;

— ensure that each hospital review the scheduling and utilisation of outpatient clinic space;

— ensure that each clinical director meets with each and every consultant providing outpatient clinics and elective treatment, to examine the scheduling of clinics and procedure lists to match scheduling to demand;

— schedule elective diagnostic investigations seven days a week;

— schedule elective surgery seven days a week;

— open without delay all ward beds that have been closed;

— expedite the bed capacity review and expand it to include a review of outpatient clinic capacity and utilisation;

— examine the potential for hospitals without 24/7 emergency departments to increase their elective work;

— direct the National Treatment Purchase Fund (NTPF) to publish all other waiting list data on a monthly basis as per the criteria used in the waiting lists currently published;

— immediately provide scheduled procedures under the NTPF and maximise the use of private capacity in this regard;

— utilise the existing community hospital network more efficiently to help prevent admissions to acute hospitals by facilitating direct admissions by general practitioners to these facilities, to facilitate post-operative discharges from acute hospitals and to work as an interface between the acute sector and the Fair Deal Scheme; and

— commit to upgrades of the community hospitals network to help alleviate pressure in general hospitals.

The motion is timely in view of the fact an Oireachtas all-party report was published today on the delivery of health care over the next ten years, changing how it is delivered and the need to fund it accordingly. In adjudicating on the success or failure of the health care system in recent years, it must be said there has been a fundamental failure on every matrix on the part of Government to deliver in a meaningful way in the key areas where there are huge difficulties, which are primarily emergency departments and hospital waiting lists. Some 660,000 people are on hospital waiting lists of one form or another. That is a sad indictment of the failure of the system to deliver in a timely fashion.

We saw this in a personal way when watching "Living On The List", the RTE Investigates programme broadcast earlier this year. It showed the impact of the delays on people's lives. That is something this side of the House has failed to highlight but, more importantly, it is something the Government has failed to address, by putting mechanisms in place to ensure people are not waiting inordinate periods for inpatient, outpatient or day-case appointments. The reason we tabled this motion is that we still believe the issue is not being responded to in a timely manner by the Government.

People will say the Government was waiting for the publication of the report of the all-party Oireachtas Committee on the Future of Healthcare. That probably gives a certain amount of cover to people who have no policies in the area of health care. However, and I hate to highlight this consistently, over the past six years Fine Gael has been bereft of any policy direction for the delivery of health care. For the first three years of the previous Government's term we spoke about universal health insurance as the model to be adopted. It was the major policy plank for funding health care in future years. Of course, it was never costed and there was no analysis of how it would be compatible with Ireland's health care system. There was no detail whatsoever in the proposal. We spend three years faffing around on whether it could be implemented. Behind the scenes, it was slowly let wither on the vine. It was eventually put out of its misery in 2014.

Since then there has been no genuine focus on the key areas of the waiting lists and the emergency departments. There are many reasons for the waiting lists, including a lack of capacity, a lack of consultants and a lack of overall coherence in assessing who is on a waiting list and in making people, both clinical and administrative, accountable for waiting lists to ensure there is proper oversight and governance in the delivery of health care. Last year, in the context of the negotiations that took place on the supply and confidence agreement, the issue of the National Treatment Purchase Fund, NTPF, was raised. A sum of €15 million was to be put aside for it and it was to be included in the 2017 Estimates. Subsequently, there has been no movement in terms of people being treated by the National Treatment Purchase Fund. At the end of May 2017, we have not seen any meaningful processing of people through the system. That is a sad indictment given that, since last June, it has been part of the supply and confidence agreement and of the programme for Government to ensure there are timely interventions for the longest waiters. That has not happened. It is very disturbing. The system should have been able to assess who has been on the waiting list the longest and who should be prioritised for treatment or consultation.

I ask the Minister to revisit this issue as a matter of urgency and to impress on the National Treatment Purchase Fund the urgency of its deliberations in terms of finding those who will be contracted to provide the services for the longest waiters. There is also a commitment that next year there will be an increase in funding for the National Treatment Purchase Fund. The reason we sought the funding for the NTPF is that the fund has been the mechanism that has been used most effectively as a safety valve, until it was cancelled by the previous Government, due to a lack of capacity in the public health system. I acknowledge that lack of capacity in the public health system. However, it is unacceptable that at the end of May 2017, the National Treatment Purchase Fund has not been taking patients off the waiting list, given that this was included in the supply and confidence agreement this time last year.

The motion is quite straightforward. It highlights some of the inadequacies in the health system and recognises the conditions being experienced by patients and staff across emergency departments, in particular the treatment of some elderly people which has been well documented. There appears to be a lethargic acceptance within the system that these things are okay. If there are 370 people on trolleys, it is no big deal. No one appears to get excited about it anymore. Some people wait for inordinate periods on trolleys. Until the figure hits 600, there is no interest in whether the system is even delivering safe health care in emergency departments. The matrix now is 600 people. We have allowed our standards and ambition to drop substantially. That was highlighted by the Minister's predecessor who effectively abandoned the waiting list targets that had been set and extended them to 18 months. Instead of trying to address the underlying concerns, the goalposts were moved. It was decided that it was now acceptable for people to spend 18 months on waiting lists.

I hope the motion receives cross-party support. It highlights the inadequacies but also calls for some tangible benefits on which I will elaborate later. I commend the motion to the House and I look forward to a good, proactive debate on it.

Deputy Lisa Chambers

I commend Deputy Kelleher for his work on this issue and his tireless commitment to tackling it. Certainly, I echo his call for a sense of urgency on the part of the Government. This is one of the main issues I deal with each week in my constituency office. I agree with Deputy Kelleher that our standards have lowered. People expect less from the health service today than they did ten years ago.

That is not the direction in which it should be going; it should be moving in the other direction.

The waiting lists continue to grow, as does people's despair because they languish on those lists for such long periods. In my constituency, Mayo, the combined inpatient and outpatient waiting list for Mayo University Hospital showed that over 8,500 people were waiting for procedures at the end of March. Over 1,100 of those have been waiting for more than a year and a half. What those figures represent is a period when we rob people of their health and the ability to go about their lives, do their daily tasks and live free of pain. Many of these individuals, some in tears, have come to my constituency office with family members because they cannot get hip replacements or other joint replacements. Since their condition is not seen as life-threatening, they are left waiting. While it may not be life-threatening, it presents a serious impediment to living a normal, pain-free life. I do not know what it feels like to live in pain for that period but I can only imagine it must be absolute torture.

People know that if they can afford private health care, they are likely to be dealt with. It is an awful indictment of a modern republic that there is a two-tier system and that those who cannot afford health care are left to wait. As Deputy Kelleher asked, when will it be too much? When will we be shocked by these figures? Nobody is shocked by the fact that there are 8,500 people on the waiting list at Mayo University Hospital. I am shocked because I have seen the impact on people's lives. I ask the Minister to demonstrate renewed urgency to get the National Treatment Purchase Fund up and running to its full capacity to deal with the waiting lists and ensure that people can resume normal lives.

Deputy Declan Breathnach

I spent 15 years of my early political career on the North Eastern Health Board trying to ensure both a regional approach and a national approach would be taken to the delivery of hospital health services. While the plan outlined in the Sláintecare report has ambitions and goals to deliver the sort of fair, affordable, effective public health system required, and while it is a cross-party plan, we will need to hear a concrete commitment not only from the current Government but also from its successors to implement this plan. I am reminded of the saying, "To fail to plan is to plan to fail." I hope it is not just a matter of paying lip-service. Rabbie Burns referred to the best-laid plans of mice and men, which, as we know, often go awry. The current state of affairs cannot be permitted to continue.

In my county, Louth, the most recent waiting list figures make for depressing reading. At Our Lady of Lourdes Hospital, 1,064 are waiting for inpatient services or surgeries. Over 200 of these have been waiting for more than a year and 18 have been waiting for more than a year and a half. Louth County Hospital has 669 people currently on the waiting list for inpatient services. Regarding outpatients, there are over 13,000 on the waiting list at Our Lady of Lourdes Hospital across all specialties and 3,088 at Louth County Hospital. These are disgraceful figures and they are disrespectful to those in need of health services.

Colleagues have referred to the National Treatment Purchase Fund. I wish to refer to the cross-border health care directive for public patients. I raised this with the Minister, Deputy Harris, previously. I asked that it be advertised. It does not suit everybody because payments must be made upfront, but the directive at least affords patients an opportunity to avail of services not being delivered within the State. The scheme needs to be advertised more proactively in surgeries and clinics across the country. Many people I tell about it say they have not been told about it, either by their consultant or doctor.

From my experience, the biggest issue for many is not knowing when to plan for the surgery they hope for. I advocate that some windows and timescales be provided in order to allow people to plan. While those who are in pain need to be seen immediately, those who may be in a position to wait will concentrate and focus on having to wait for the specified period if they get a window.

Deputy Frank O'Rourke

I welcome the opportunity to speak on this motion in support of my colleague, Deputy Kelleher. I acknowledge the commitment to and investment in this area. I also welcome today's report on the future of health care. This all raises a problem, and the question to be asked is why we are not seeing the delivery of services to deal with the massive waiting lists affecting people every single day. Considering that the lists are growing day by day in all constituencies, this is a major problem. We must ask why it is not improving. We are saying that the resources are in place, as are the staff, although, perhaps, not at the coalface. The management staff are in place. Is it that management staff in the HSE are not responsible or accountable for delivering the services for the people who need them? Is it that the staff face no consequences if services are not delivered? It is wholly unacceptable that people must wait four years for their cases to be deemed urgent in the context of surgery or some other treatment.

Currently, routine services, treatments and hospital surgeries are not delivered after 4 p.m. on a Friday in most cases and services do not recommence until perhaps 9 a.m. on a Monday morning, or a Tuesday if there is a bank holiday. That is not good enough at all and it is a problem.

With regard to adult spinal surgery, I meet the top neurosurgeon from Tallaght regularly. The number on the waiting list in my constituency, Kildare North, which includes Naas hospital, is 525. This is up 32% in a year, all because somebody is not doing what is required regarding the necessary surgery facilities and theatres, made available at a cost of €4 million. Doing so would help solve the problem. The Minister is talking about it. I have spoken about it in this Chamber at length but nothing is happening. We have to get real and deliver services in order to reduce the waiting lists that are affecting so many people negatively in my constituency and throughout the country. Currently, there are between 1,500 and 2,000 on the waiting list in Naas. In Tallaght, the hospital directly affected by this, the number is 7,000. I ask the Minister to take that on board and examine the reasons why we are not delivering.

An Leas-Cheann Comhairle

I remind the Fianna Fáil group that only five minutes are left. Members need to be economical with the time.

Deputy Jack Chambers

We will be economical with the time but the health service is not economical with its budget. The Minister has inherited a long-term issue concerning public health policy, in respect of which no one has got it right. We have one of the biggest public health budgets we have ever seen, with some of the worst outcomes. According to the European Health Consumer Index, we spend four times the amount spent by Greece and Slovakia but we have the same hospital throughput. We have seen the Shortall report and many ideas about spending more money, throwing more hundreds of millions of euro at the problem and offering free GP care, free accident and emergency services and free services for everyone. That just does not work. It is a utopian approach that is not being realistic or honest with people. Thousands of Irish people have been suffering, acquiring disabilities, developing morbidities and dying on our waiting lists. We heard about the scoliosis patients and people having to wait a year and a half for a bypass procedure in the Mater hospital that is crucial to their lives. We know people on the list who have died.

Clearly, we need to invest in a national treatment purchase fund that actually delivers outcomes for patients and by means of which the State can measure its investment. The public health system needs to be examined. The Irish Times carried an excellent article by Cathal O'Sullivan last weekend. It was about trying to be imaginative about specialties within the hospital system. There are generalists and specialists but the former manage the acute load in terms of the accident and emergency departments and the specialists manage the elective procedures and the complex cases. It is important that we do not become experts on spending more. That appears to be the common thread in the solution offered. It should be about doing more with what is currently being spent.

Deputy Robert Troy

I acknowledge that the Minister is relatively new to his Department and, unlike his predecessor, I am sure he is not chomping at the bit to get out of it. Everyone present will provide endless examples of constituents in urgent need of emergency surgery. Only today, a 64 year old woman from Granard in County Longford who has been waiting months upon months for a critical operation contacted me. She was due to have her procedure today but there was no bed. A lady from Kilbeggan rang me last week. She was due to have her operation in the private system in the first week in June but it has been postponed until the end of August. We have a scheme in place whereby people can get reimbursed if they go to the North for a procedure. That is something people find quite remarkable.

The report of the all-party committee was published today.

If it is implemented, that is welcome. We have plans and we have the National Treatment Purchase Fund that was set up as part of the confidence and supply arrangement in January of this year. It is not being implemented. It is there but not one penny of it has been spent. Why is that?

In the last few seconds of my time, I wish to highlight the serious delays in the processing of medical cards. We have reverted back to a situation in which people are waiting up to two months having completed the medical card application perfectly. We are going back to a situation whereby it is becoming overly restrictive for people with medical needs who need to get a discretionary medical card. The Minister should examine that issue.

While some people will get on hospital waiting lists, there are others with rare diseases and as a Government and a country, we are failing them. The Minister needs to implement his promise in the programme for Government to ensure that people with rare diseases can get treatment.

Deputy Marc MacSharry

I will cut to the chase. Often in these debates, we hear a lot of examples, as Deputy Troy has just highlighted. How about a few solutions? Many times, I have suggested in this House that when it comes to waiting lists, there is the example of the NTPF, which others have used already. It is time the Minister started implementing it and increasing funding to it.

Another thing on which I do not see any emphasis in today's report, which is sad, is a relaxation on the means test for the carer's allowance. There is not a family in the country that would not be delighted to care for a loved one, elderly, infirm or otherwise, for the benefit of other home supports such as a medical card and others. It would be much cheaper to encourage people to stay in their own home. That in turn would free up acute beds and beds in nursing homes. It costs €1,000 per day on average throughout the country to stay in a nursing home and €1,000 a day for an acute bed.

We also need to resource primary care. What will it cost to put a practice nurse into every practice to carry out mild trauma treatment, suturing, ECGs and so on to again keep people away from the accident and emergency departments?

I have to mention child and adolescent mental health services. Throughout the country, they are a shambles at the moment. As of April, appointments had yet to be made to 82 positions. There is no child psychiatrist in Sligo although there are 480 children waiting to see a psychiatrist, of which 87 are urgent cases. We are depending on the goodwill of a retired guy to come back and work 20 hours a week to see the urgent cases. I commend the Enough is Enough campaign in Sligo and throughout the country. Ms Yvonne Rainey, Mr. John Doyle and Ms Michelle Fletcher are spearheading it there and there are many others throughout the country.

The Minister knows that talk is cheap. It is time for action. I have given a few basic suggestions. I ask him to please at least have them costed.

Minister for Health (Deputy Simon Harris)

I want to begin by thanking Deputy Kelleher and his colleagues for tabling this motion and for providing the Dáil with the opportunity to debate the interrelated challenges of waiting times for elective care, emergency care and wider capacity issues in the health system. As with other speakers, I approach this debate conscious that the future of health care committee published its report today. I want to commend the committee members on their contribution to this unprecedented cross-party effort. I am committed to forging political consensus on health wherever possible and I can confirm that in that spirit the Government will not be opposing this motion.

It is also important that we debate this motion in context. We are debating this motion after a lost decade of economic investment in our public services. I also agree with Deputy Jack Chambers in that the debate about health care does need to be about more than just euro and cents. It needs to be about structures, outcomes and accountability. I will touch on some of that in a moment. All Members in this House share the same desire to place patients and their needs at the centre of debate. It is up to the political system - all of us collectively - to find ways to reach sustainable solutions within the available resources. On that note, I must point out there are some issues in this motion that have significant cost implications and I will return to these later. First, I want to talk about the long waiting times facing too many of our patients, the burden this places on patients and their families and the efforts I am making to address this. The considerable rise in these numbers has been due to many reasons, not least our past economic situation and consequent reduction in investment in health. On the other hand, we have seen a consistent rise in demand for health services due to our growing and ageing population. I have been working with the HSE, the NTPF and my own officials to put initiatives in place to address these long waiting times that so traumatically affect people’s quality of life.

In recent months, the HSE has developed a number of waiting list action plans. These plans are now finalised and I sincerely welcome them. I am also pleased to announce that their implementation has already commenced and I have been advised they are on target. Today, we have published a specific action plan for scoliosis, which will aim to ensure that no child will be waiting more than four months for spinal fusion and other spinal procedures by the end of 2017. To date, around 100 spinal surgeries have taken place in Our Lady’s Children’s Hospital, Temple Street Children’s University Hospital and Cappagh National Orthopaedic Hospital. Outsourcing to hospitals nationally and abroad is currently under way. In April, a new orthopaedic theatre opened in Crumlin ensuring that spinal surgeries in the hospital are being conducted with leading-edge technology in the most up-to-date environment. With ongoing nurse recruitment, it is expected that theatre capacity will increase by an additional two days a week with effect from July. I believe all of us were disgusted with the situation facing children and adolescents with scoliosis. I thank the advocacy groups for their input into this plan published today. It will ensure that no child or adolescent will wait longer than four months for a scoliosis procedure by the end of this year. That brings this country in line with the NHS.

The inpatient day-case and outpatient waiting list action plans focus on reducing the number of patients who will be waiting 15 months or more for inpatient day-case treatment or outpatient appointments by the end of October of this year. The inpatient day-case action plan aims to remove over 29,000 patients by the end of October through a combination of normal hospital activity funded under the HSE's national service plan, as well as both insourcing and outsourcing initiatives utilising €15 million of NTPF funding. The list has already been reduced by over 12,000 patients under this plan. I am sure Deputy Louise O'Reilly will welcome the fact that some of that will be insourced and it will not all be outsourced to the private sector. The outpatient plan will seek to remove over 95,000 patients by the end of October and over 36,000 patients have had their outpatient appointments under this plan to date.

In addition to the HSE's waiting list action plans, last December I granted approval to the NTPF for the first tranche of funding in the region of €5 million for an initiative focused on those waiting longest for day-case treatment with a view to ensuring that in excess of 2,000 patients waiting more than 18 months for a day-case procedure will have received an appointment for their procedure by the end of next month. The NTPF has advised that currently, more than 300 patients have accepted an offer of treatment in a private hospital. While it took some time to ramp up the NTPF in terms of its own procurement processes, patients are today receiving appointments through that process.

Consequently, through these action plans and the €15 million of NTPF funding for patient treatment allocated in the last budget, I am determined that as much progress as possible will be made to reduce the numbers of those patients waiting the longest for treatment. I will be meeting the HSE and NTPF on a regular basis throughout 2017 to ensure that the maximum number of long-waiting patients receive treatment under these action plans and that best value is achieved.

I have also instructed my officials to commence planning for 2018 immediately in light of the increased allocation for next year. As part of this process, priority will again be given to the longest waiters, where possible, and the aim will be to build a long-term sustainable solution towards long waiting times in particular areas and specialties based on the robust analysis of the demand and capacity within the system to deliver services appropriately. We need to be planning for next year already now that we know that the NTPF is back up and running.

I also wish to address briefly the point made in the motion regarding the waiting list initiative of 2015. That year, additional funding of €51 million was allocated to the HSE to maximise capacity across public hospitals or to outsource activity. At the end of 2015, the HSE reported 95% achievement for the inpatient day-case waiting list and 93% achievement for the outpatient waiting list against the 15-month maximum wait times. In fairness to my predecessor, it is important to put that on the record of this House.

It is important to note that as of last April, less than 7% of patients on the impatient day-case waiting list and less than 10% of patients on the outpatient waiting list were waiting 18 months or more for their procedure or appointment, though that is still far too many. Nevertheless, I fully accept that significant improvements are needed in this area to ensure that patients are seen and receive treatment in a much more timely fashion. Therefore, I wish to emphasise that the work due to take place this year is only the first step towards a more sustainable and sustained reduction in waiting times for patients. The NTPF allocation for 2018 will rise to €50 million and planning for next year has already commenced, as I have said.

I will now move on to discuss the issues raised on emergency department, ED, overcrowding, again referenced in the motion, and the development of initiatives in this regard. Our health service continues to see an unacceptable level of overcrowding in emergency departments and I acknowledge the distress this causes to patients, their families and those front-line staff working in extremely difficult conditions in hospitals throughout the country. I have stated repeatedly that the answer to this problem has to lie in increased capacity, that is, more beds, more staff and more capacity in primary care.

However, there has been progress in 2017. If we do not acknowledge the progress, we cannot build on it and try to tackle the issues. Already, data indicate there has been a 2.9% reduction in patients waiting on a trolley nationally at the end of April 2017. Statistics and percentages can be lost on all of us, but this equates to more than 1,269 fewer patients waiting on trolleys this year compared with the first quarter of 2016. It is still too many, but more than 1,200 fewer patients are on trolleys this year than at the same period last year.

We have discussed the winter initiative many times here so I will not repeat the elements of it again tonight except to say one of its more general benefits was to enable improved responsiveness by the HSE and the Department in responding to periods of significant emergency department demand. Emergency department performance this winter illustrated that many model 4 hospitals showed the ability to maintain or improve emergency department performance this year and, in particular, bounce hack effectively after periods of surge in emergency department demand. Moving forward, we need to put in place measures to support capacity and process improvement in some of our smaller model 3 hospitals and those hospitals in the west and south which experienced challenges during the winter. The development of co-ordinated winter plans between hospital groups and CHOs continued to facilitate and support improved responses to winter pressures across primary, acute and social care for the benefit of patients.

Since the conclusion of the winter initiative at the end of March, my Department and the HSE have both engaged in a "lessons learned" process involving looking back at what worked this year - some things did improve, particularly relating to a reduction in delayed discharges - and what did not work. Many things did not work and need improvement. The winter initiative also recognised the interrelated interdependent nature of the environment within which public hospitals operate and, as such, was cognisant of the need to increase capacity within our health services. Under the winter initiative, 90 additional hospital beds were opened in Mercy University Hospital Cork, University Hospital Galway, the Mater, Beaumont and Mullingar. This work continues and I was delighted just this week to welcome the opening of the new emergency department at University Hospital Limerick, an emergency department that is three times the size of the previous one. I look forward to visiting it next week.

Notwithstanding these improvements, I have repeatedly made clear that increasing capacity within our health service is a priority. My Department commenced a capacity review earlier this year in line with the commitment in A Programme for a Partnership Government. Unlike previous years, it will look at the range of capacity, not just capacity in the acute hospital sector. Work is progressing, the steering group has met twice, external contractors will commence work in early June and I look forward to its findings later in the year.

As I mentioned at the start, there are some proposals in this motion that have significant cost implications for the Exchequer and are not currently funded under the national service plan 2017 or the budget passed by this House. However, I will consider these proposals and any constructive suggestions in the context of budget 2018 and winter planning.

Before I conclude, I would like to add that in order to achieve significant improvements in patients' experiences and improve capacity in the public health service, broader reforms are needed. I think this is something with which we would all agree. For example, we need to further develop the strategic synergies of hospital groups and ensure that the role of smaller hospitals is strengthened in appropriate areas of service delivery. We also need to properly develop and embed primary care as the bedrock of our health system. The Oireachtas Committee on the Future of Healthcare has made a series of recommendations regarding overall capacity in our health system, including specific measures to tackle emergency department waiting times and overcrowding and waiting times for diagnostics, outpatient appointments and elective procedures. I look forward to considering the report and its recommendations in full in the coming days. It is my intention to have an initial discussion at the next Cabinet meeting in advance of a full Dáil debate on the report in June.

Deputy Louise O'Reilly

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"notes:

— that the Irish health service is in a continuous state of crisis;

— that more than 660,000 people are on a hospital waiting list;

— that there are in excess of 100,000 outpatient appointments outstanding for over a year as of May 2017;

— that these targets were not met and still have not been met, and even if they were met they would still constitute some of the worst waiting time situations in Europe;

— that 46,629 outpatients were on the waiting list for more than 18 months in April 2017;

— that 5,770 patients were on the inpatient and day case waiting lists for more than 18 months in April 2017;

— that Ireland has a discriminatory health service, where public patients wait significantly longer to access essential medical services than people who can afford to pay privately; and

— the success of the integrated Information Technology (IT) system used in the Portuguese National Health Service which has, alongside greater investment in public hospitals, delivered significant and sustained reductions in waiting times for surgery

since it was first introduced in 2004, namely over five years the waiting lists for surgery have decreased by almost 35 per cent, the median waiting times by almost 63 per cent and variation across providers is also diminishing;

further notes:

— the very great distress and pain being suffered by people enduring long periods on hospital waiting lists, as well as the distress and suffering caused to their families;

— that under the current waiting list system, waiting lists for outpatient appointments, diagnostic tests, day case and inpatient procedures vary drastically from one public hospital to the next;

— that patients do not know where they stand on the list, nor at what speed their list is moving, relative to that of other hospitals within reasonable travelling distance;

— the fact that the long waiting times are further exacerbating the clinical conditions which need treatment, thereby producing more pain and suffering;

— that people with comparable health concerns can wait very different lengths of time for assessment and treatment depending on the hospital to which they happen to be initially referred;

recognises:

— the fantastic work carried out by health care professionals in the Irish health service;

— that in 2007 the recruitment embargo was introduced in the health service, two years ahead of all other public service organisations;

— that the waiting list crisis is one of access, capacity, funding and resources;

— the deplorable and dangerous overcrowding that continues to be experienced in hospital emergency departments and wards;

— the record number of patients waiting on trolleys, particularly the frail elderly, during the first four months of 2017;

— that such overcrowding results in further delays in scheduled hospital treatments and essential surgery, thereby further worsening the waiting lists; and

— the comments by the Director General of the Health Service Executive (HSE) that should the trend in presentations to emergency departments continue, all work will be emergency work and hospitals will be unable to accommodate elective work; and

calls on the Government and/or the HSE to:

— provide the necessary increases in resources, both financial and human, for our health service to function in the manner necessary to best serve our people and our healthcare professionals;

— make the Minister for Health legislatively accountable for the delivery of health services;

— hold the Minister for Health and hospital chief executives accountable for the open disclosure of accurate data on waiting lists in each hospital;

— require the Minister for Health to publish monthly hospital waiting list figures, giving a specific breakdown of numbers on waiting lists, length of time on waiting lists, progression or regression of numbers on waiting lists, detail on outpatient waiting

lists, access to diagnostic waiting lists and elective surgery lists;

— provide the necessary increases in resources, both financial and human, for hospitals to carry out elective diagnostic investigations and elective surgery unhindered;

— open, without delay, all ward beds that have been closed;

— ensure adequate registered nurse/doctor-to-patient ratios and sufficient beds in the acute hospital sector to deal with demand and the demographics of the local area;

— ensure that we have adequate numbers of healthcare professionals and to protect them from exploitation and overwork, and to provide the support they need to carry out their duties;

— combat the exodus of workers to the private sector and overseas, by addressing the failures that workers and their unions themselves outline in the health service;

— ensure the provision of a greater Core Activity Budget to public hospitals to increase their capacity;

— increase investment in the HSE IT budget to bring it in line with the European Union average, with a view to increasing this further;

— fast track the roll out of the Electronic Health Record;

— empower local managers to appoint necessary frontline staff;

— explore the feasibility of a new model to maximise the capacity of the public hospital system, and introduce fairness and strategic management across all waiting lists, the component parts of which should be:

— the introduction of Comhliosta – a new and single Integrated Hospital Waiting List Management System to cover all participating health facilities;

— the provision of a greater Core Activity Budget to public hospitals to increase their capacity;

— the introduction of a new Comhliosta activity fund to cover the cost of procedures for those patients transferred via the integrated waiting list to a different participating health facility; and

— an end to the treatment of private patients in public hospitals;

— increase necessary resources, both financial and human, to the public health service and move away from the provision of treatment under the National Treatment Purchase Fund (NTPF), which has not only failed in significantly reducing waiting

times, rather, it reinforces the idea that private healthcare is the panacea to problems in the public system; and

— expedite the move to deliver healthcare in primary and community care settings to proactively deal with health issues, thereby reducing admissions to acute hospitals, facilitating discharges from acute hospitals, facilitating post-operative recovery in a more beneficial environment, and relieving pressure on general and acute hospitals."

The Minister referred to issues of capacity and referenced the new accident and emergency unit in Limerick, which was long overdue. Indeed I stood on a picket line with the nurses there when Fianna Fáil was in government. We were striking for more staff. The then Government did not give them to us. We warned at the time about the capacity issues that were coming down the line. The then Government did not listen to us. You guys came along and did not listen to us either. Lo and behold, the accident and emergency unit opens and there are over 30 people on trolleys. The reason they are on trolleys is because we have a capacity deficit in the health service. We will not address the issue of capacity within the public health service by putting money into the private sector. This is why Sinn Féin is proposing an amendment and why we are not in a position to support the Fianna Fáil motion because writ large in it is privatisation via the NTPF.

The Minister is carrying out a survey of people in our health system, which is to be welcomed. That is like winning the lottery. As one woman told me, it is very tough to get into the health service but when you get in there, the care you get is second to none. I salute the doctors, nurses, theatre porters and the people who clean our hospitals because they are working in intolerable conditions and indeed are leaving in large numbers for that reason.

The survey looks only at those who have been lucky to get in the door. We leave it to "Prime Time Investigates" to survey those who cannot get in the door. We have seen the results of that on a number of occasions and have all agreed that this is unacceptable yet we still come back to the position whereby the Government of the day and its best friends supporting it still think that somehow we will be able to improve the public service by putting money into the private sector.

There is a reason there is capacity within the private sector. It is because well-trained and highly-educated staff are leaving our health service along with students graduating from our universities and going into the private sector. They are being attracted by bonuses. Of course, they are doing so because we are here this evening discussing a revenue stream that will go directly into the private sector from the public purse. The Minister knows this because I have said on countless occasions that we will never sort out a problem of capacity in the public service by putting money into the private sector. A total of 660,000 people are on hospital waiting lists. We can and did agree that this is not acceptable. We had cross-party agreement. The Committee on the Future of Healthcare reached consensus on a large number of issues, chief among which is the need to only spend public money in the public good. I put it to the Minister that the only way to ensure this money is well spent is to ensure that it is spent resourcing public services.

We must also remember that when we discuss issues of capacity, the moratorium on recruitment in the health service was brought in two years ahead of the one introduced in the rest of the Civil Service and public service. I know this because I had a trip to the Labour Court as a direct result. Fianna Fáil was in government then. The bright idea of the NTPF did not work. It had no long-term impact. It might make a nice soundbite to say we can send someone to a private hospital or to England or France to have an operation but, in truth, it is not true to say that people do not care where their operation is done and that they are happy to go along. People want a decent, well-resourced and fully staffed public health service and they will not get it if we keep putting hard-earned money into the private sector. It is counter-intuitive to suggest that putting money into the private sector will somehow magically improve the public service. It will not. Therefore, we are proposing an amendment to the Fianna Fáil motion. Our amendment focuses on capacity but it also focuses on Comhliosta. The Minister will be aware of this. Sinn Féin has put forward a proposal and I know the Minister is examining this at the moment. We would like to see this extended to the whole island. We believe that what has happened in Portugal in terms of a single integrated waiting list management system is a really important step towards us being able to manage waiting lists. We will not be able to improve services in the public health service unless we invest in the public health service.

Deputy Peadar Tóibín

There are 660,000 people on HSE waiting lists. This is the equivalent to the populations of Leitrim, Longford, Carlow, Monaghan, Roscommon, Sligo, Cavan, Offaly, Laois and Westmeath. These ten counties represent about one third of the State. Every access point to the health service is being closed off by this Government. The last point of access for many people - accident and emergency departments - are hammered.

Last year, in the Louth-Meath area, about 9,000 people were on those waiting lists. These people are not counted among the 660,000 on the waiting lists. What do these people have in common? First, they are the most vulnerable people in society. They are the people who are most ill. The majority of them are in serious pain or discomfort. Many of them have had to stop working and are in forced economic dependence on the State. Many have lost their independence and have had to go into care or be cared for by their family and friends.

The second thing they have in common is that they are from low and middle-income backgrounds. They are the collateral damage of Fine Gael's economic policies and the symptom of the model of government Fine Gael has chosen. They are 660,000 of the sickest and poorest people in the State whose lives have been suspended for months if not years of pain. In my county, roughly 25,000 people are on waiting lists.

In Our Lady's Hospital in Navan, outpatient waiting lists in February 2017 comprised approximately 5,276 patients. This is a massive figure, but it is not the whole figure, because many Meath people are on waiting lists elsewhere. The number of people in Our Lady's Hospital waiting for longer than 12 months was 582. The number of those waiting longer than 15 months was 321. This is despite a programme for Government promise in 2011 which said that no patient would have to wait longer than 12 months for a hospital appointment.

It has not happened by accident. Take my own hospital in Navan, for example. It was Fine Gael's policy in recent years that the endoscopy theatre would be closed every Friday. It has been Fine Gael policy that the general surgery theatre was closed every Monday. It has been official Fine Gael policy to have significant caps on the orthopaedic operations in our hospital. Some doctors have told me that, over the winter period, in the five months of last winter, they were only allowed to carry out operations for five days. There are the overheads, capacity and much of the resources, but there are still blocks with regard to delivering services.

What does this mean for real people? Yesterday, an elderly gentleman came into my office in Trim. He had two cataracts. He is left practically blind at the moment. He lives on his own. That is shortly going to be "he lived on his own". An elderly man who is practically blind, or very badly sighted at the moment, is not going to be able to function independently. He has told me that his operation is over a year away at the moment. What could I say to this proud and independent man yesterday except that I would do my best and ring the doctor to see what happened? I am sure the doctors in the hospital took dozens of calls that day from similar individuals. A woman in her 50s in Westmeath contacted me. She was diagnosed with chronic pain in her back. She has numbness and swelling in her legs and she has a constant urge to urinate. She was put on the waiting list for surgery in June 2016 and doctors have told her to try to go private. She just does not have the money to do that. Then doctors told her to present herself at an accident and emergency department and that there was a good chance she might get some level of emergency surgery in that space. Her operation has been put back repeatedly, and she is now in excruciating pain for 365 days and nights. I know a number of kids who have come into my offices who are trying to do exams while seriously ill and on waiting lists as well.

The problem with this is that it is a false economy. On an individual basis, if diagnosis is delayed, the treatment to an individual is delayed and that person's health crisis is going to deteriorate. He or she will need more crisis interventions in the long run. These crisis interventions will cost much money and will clog our acute services. Replicate this over the whole population and there is a Fine Gael health service in crisis.

Deputy Denise Mitchell

I welcome the opportunity to speak on this important issue. Unfortunately, it feels like Groundhog Day. Yet again hospital waiting lists have hit an all-time high. Yet again we are back in this Chamber discussing the inability of Government to tackle the crisis. It seems we are doomed to repeat this until someone gets his or her finger out, shows a bit of backbone and finally makes the call to implement serious and radical changes in our health system. One would think that someone would have copped on that tinkering around the edges clearly is not working. At the start of May, 666,000 people were on hospital waiting lists. Let that number, 666,000 people, sink in for a moment. That is 58,000 more people on waiting lists since the formation of this Government.

These are not just statistics. Behind these figures are real people. It could be someone's child, mother or grandparents. I had many people on to my office speaking about how they were preparing for a serious operation only to get a phone call a few hours beforehand to be told it was cancelled or postponed. This is not good enough. The Government gave a commitment in January 2015 that no citizen would be waiting longer than 15 months for treatment. That commitment clearly has not been met. In my local hospital, Beaumont, more than 26,000 people are waiting for outpatient appointments this month. That includes 3,100 people waiting for 18 months or more.

It appears that the Government has no real plans to tackle this issue while the public is sick and tired of listening to the constant reassurance that the Government is working on it and while waiting lists grow and pressure continues to pile on front-line workers. We need real investment in health. We need more doctors and more nurses. We need a real public health care system and an end to the failure of this two-tier policy.

Deputy Carol Nolan

Táim buíoch as ucht deis labhairt ar an ábhar fíor-thábhachtach seo anocht. As we know, our health service is in continuous crisis, with more than 660,000 people on hospital waiting lists throughout the State. Despite all the spin by the Government, the modest targets for the reduction in waiting times have not been met and that is the fact of the matter. Even if they had been met, they would still be the worst in Europe. Fianna Fáil, Fine Gael and the Labour Party have presided over chaos in our health system. It is ordinary citizens, along with the overworked and exhausted staff in our hospitals, who are doing their very best in spite of the circumstances. They have paid and are paying the price.

In my constituency of Offaly, the emergency protocol was activated 230 times in the Midland Regional Hospital in Tullamore in 2016. This was the third highest in the State. There has been an ongoing overcrowding problem in the emergency department of the hospital, and this has led to many last-minute cancellations of elective surgery, with many elderly people being affected. Chronic under-resourcing of our health system has led us to this point.

This motion by Fianna Fáil is all style and little substance, but that is no surprise. It lists the problems but does not identify the solutions. Fianna Fáil introduced a recruitment moratorium in the health sector in 2007, two years before the rest of the public service. The proposals to schedule surgeries and diagnostic investigations at the weekend are nothing short of populist drivel and the point has been completely missed.

Our health service needs resources. Shuffling staff about is the equivalent of arranging the deckchairs on a sinking Titanic. Fianna Fáil, Fine Gael and the Labour Party have presided over the loss of 4,448 nurses between 2007 and 2017. The previous Government cut health funding by 20% and the number of health care staff by 12%. Now the people involved stand here and scratch their heads and wonder how they can fix the problem. All the while, hundreds of thousands of patients are waiting in pain for treatment. Resources, investment, action and political will are required. The solutions are simple, and there has to be true commitment to develop a quality health system that treats people based on need rather than ability. That is the way forward and the way we need to take. I fear that commitment is missing from the parties on both sides of this House and all the motions in the world will not fix that problem.

Deputy Gino Kenny

I am sharing time with Deputy Mick Barry. I support some of the observations and aspirations in this motion but, sadly, it is largely aspirational unless we have a fundamental policy change for health care in this country. As Deputy Nolan says, there is a human story behind every statistic in this motion. Some 660,000 people are on waiting lists. That is 660,000 individuals. The 100,000 outpatients are 100,000 individuals. We are sanitised to those human stories both inside and outside this Chamber. We can wax lyrical on what is going on with the health service, but there needs to be health service revolution, from the bottom to the top, and that has to be driven by front-line staff rather than HSE middle managers.

Today we are talking about the long waiting times for people. There was a report on this in The Irish Times last week, which I mentioned to the Taoiseach. It is extraordinary that 2,000 children are waiting for initial mental health appointments and Barnardos has said this is causing unnecessary consequences for those children.

One can include what is happening in Lynn Dara. Eleven beds have been closed in Lynn Dara for one reason only, because of the shortage of nursing staff. Nurses are leaving the health service. As I said to the Taoiseach last week, there is almost a two-tier pay system in the medical profession because health care workers in the public sector are being enticed by the private sector. The reason Linn Dara is closing down for three months with the loss of 11 beds is the shortage of staff.

Nursing staff are looking at the public sector pay talks with an eye to their future. Numerous beds and theatres have closed down across the country. Health care workers are looking at the public health system and they see a sick system. I worked in the health care system for a long time. The majority of the time one has a very good experience in the public health care system, but when it comes to waiting times and waiting for beds, it is a sick system.

The other statistic that stands out is that since 2008 and the crisis in this country, 3,500 nurses have been taken out of the public health system. That is a 9% reduction in nursing staff. Of course, one will have a perennial crisis. Also, the mental health care staff is 21% lower than recommended. Of course, one will have a crisis.

My question to the Minister is simple. Does he believe in a universal health system? I do not know whether he does.

Deputy Simon Harris

I do.

Deputy Gino Kenny

On numerous occasions I have had this argument about the health service being ideologically run because of the two-tier system.

Fianna Fáil's motion is hypocritical. In 2001, 2002 and 2003, the then Minister for Finance, Mr. Charlie McCreevy, was giving subsidies to builders to build a lot of private hospitals.

We will continue to have this perennial problem. I am sure the Minister does not want this to be happening. We will have this crisis constantly unless we deal with the fundamental issue of the health service. The fundamental reason there is a crisis in the health service is that it is a two-tier health service. The privatisation of some public hospitals and the public system is causing the crisis. Sometimes it is not about money. Sometimes it is about staff and people. People make it a good health service. It is a good health service when one accesses it but waiting times for beds are not acceptable. When there is a system of universal health care, regardless of how much one has in one's pocket, we will have a system about which everybody will feel confident and proud. Until then, we will have crisis upon crisis.

Deputy Mick Barry

Deputy Gino Kenny is entirely correct. We have a two-tier health service and the National Treatment Purchase Fund should be shut down. All the moneys that are set aside for it should be invested instead in the public health service. Between 2002 and 2013, there was €676 million transferred to the private sector through the National Treatment Purchase Fund. This year and next year, a further €70 million will be transferred. We would have a much-improved public health service if that funding had been invested in the public health services rather than transferred out of them through this fund.

The National Treatment Purchase Fund will be of little or no use for complex less lucrative treatments because of the cherry-picking of the private hospitals. They like the simpler operations. They like the more profitable operations, such as cataracts, varicose veins, and hip and knee replacements. The complex, less lucrative treatments are in significant measure left to the public system. It is yet another example of the private sector piggybacking on the public health service.

Dr. Peter Boylan told the Joint Oireachtas Committee on Health:

The NTPF is a bad idea. That money should be invested in the health services immediately. What happens is that somebody who is on a waiting list for years is sent to a doctor they have never seen before for a pre-planned procedure that might not be appropriate. They get the procedure and never see the person again. It is grossly unsatisfactory. It is just bad clinical practice and it should be abandoned.

The motion talks about reopening closed beds. A major reason there are so many closed beds on closed wards in the hospitals is a lack of staff. The crisis the HSE has with recruitment and retention of nurses, midwives and other grades is not entirely about pay rates, but pay rates are an important part of this. The pay cuts that have been suffered by the public health nurses and other staff must be reversed. There should be cost-of-living increases which take full account of increases in the price of accommodation and they should be paid not a penny less than their counterparts in the private health care system. That would mean the private system could no longer poach from the public system staff who have been publicly trained and publicly educated.

The motion talks about transparency on hospital waiting lists. We support the publication of the hidden lists. We support one national waiting list bringing together both the public and the private. We are opposed to allowing private patients skip the queues. We want an end to the setting of targets for private income public hospitals to offset austerity cuts, and instead the cuts to be reversed. Finally, we want the section 38s, the voluntary hospitals etc., taken into full public ownership. The independent management structures are a recipe for a lack of transparency. If one wants a transparent health service, one needs a fully public health service.

Deputy Thomas P. Broughan

I am sharing time with Deputies Pringle and Connolly.

I am delighted to have the brief opportunity to speak on this health motion which, ironically, is being brought to us by the Fianna Fáil Party which played a large role in the almost annihilation of many aspects of the health system since 2008. When one looks at the basic information on the motion, that more than 660,000 people around the country are on a hospital waiting list, more than 100,000 outpatients are waiting for more than a year for an appointment and more than 46,000 outpatients are on a waiting list for more than 18 months according to figures from April 2017, most citizens will conclude that the health service is just not fit for purpose.

Of course, it is extraordinary that the present leader of Fianna Fáil is a former Health Minister. The Ceann Comhairle will remember the days when the Deputy was under considerable pressure in this House and facing votes of no confidence. It is also amazing that a putative leader of Fine Gael this week passed through that Department without hardly making a mark - I cannot remember a single important announcement - and apparently, according to a former Minister, Ms Nora Owen, fled out of the Department before he was asked to take any major decision.

On 6 February last, we were shocked, appalled and disgusted by the "RTE Investigates: Living on the List" programme which showed the reality of a life of pain for tens of thousands of people awaiting procedures in our hospitals. The programme also highlighted the disingenuous way in which waiting lists are being administered and reported through the National Treatment Purchase Fund. The NTPF excluded data from the pre-admit lists in its monthly reports, a figure that stood then at 22,927 patients nationwide waiting up to 18 months for surgical procedures.

There were almost 59,000 patients on the pre-planned list, including patients who needed treatments such as hip replacements and children who needed scoliosis surgery. Like all other Deputies, I am often contacted at my weekly information clinics by people who are at their wits' end waiting on these appalling lists for treatment. What has been particularly frustrating recently is the number of older constituents with cataracts who are waiting for more than a year and whose eyesight is deteriorating rapidly, as well as those who are waiting on hip replacements.

Since June 2016 I have been awaiting a reply from the Minister about the status of the new accident and emergency department at Beaumont Hospital. The previous austerity Government highlighted the new accident and emergency project but did nothing to bring it to fruition and the current Government is also dragging its feet on it. I am also awaiting replies on the National Treatment Purchase Fund pre-admit and pre-planned procedure lists and the number of patients awaiting knee and hip operations at Beaumont Hospital. I have written to the Minister's office directly requesting replies to my parliamentary questions and I would ask him to expedite that.

Finally, I wish to welcome the publication today of the report of the Oireachtas Committee on the Future of Healthcare, led by Deputy Róisín Shortall, which offers great hope for the future. I also welcome the fact that the Minister seems to have broadly welcomed it and hopefully the Oireachtas Committee on Budgetary Oversight will discuss it further.

Deputy Thomas Pringle

I also welcome the report from the Oireachtas Committee on the Future of Healthcare. Unfortunately, however, it will sit for a long time on the shelf before anybody dusts it off and looks at it again. I have no faith that either of the two larger parties in this House will actually implement its recommendations because it goes against their ethos for the development of the health service.

The fact that 660,000 people are on hospital waiting lists and a further 100,000 are waiting for outpatient clinic appointments is a sad indictment of the treatment of the health service for more than 30 years by this House. The health services had not recovered from the cuts imposed in the 1980s by the time the cuts of 2008 were imposed and they have not recovered to this day. Deputy Broughan mentioned people waiting for cataract operations. A constituent of mine had to have cataracts removed but was told that he would have to wait for more than a year to have the procedure done in Sligo General Hospital. He asked his consultant what the situation would be if he opted to have it done privately and was told that it could be done within two weeks. He paid €800 and two weeks later he went into the public hospital in Sligo to have his cataract removed. He had his second eye done a few weeks later. If he had stayed in the public system, he would probably be blind before being treated. That is the kind of health service this and previous Governments have developed and pushed on. We now have a situation where the managers of hospitals in my constituency are suggesting to patients who are looking for appointments that they should make an application under the treatment abroad scheme to be treated in Northern Ireland. It is difficult for managers in our health service to make such a suggestion but that is what they have been reduced to. I know of one patient who was told he would have to wait for four years for a lung capacity test in his local hospital. I know of patients who have been triaged for an "urgent" orthopaedic appointment who have been told that the waiting list is two years long. That situation is replicated right across the country.

Fianna Fáil's only solution is to ramp up the NTPF and to pump more money into the private sector. That will not deal with the issue but will just put a lot of money into the pockets of private consultants and the coffers of private hospitals and ultimately, that is the goal. What we need to see is an opening up of the operating theatres in our public hospitals and the provision of adequate staff. Our public hospitals can tackle our public waiting lists if they are properly funded to do so.

Deputy Catherine Connolly

I am grateful for the opportunity to take part in this debate. While I do not entirely agree with the motion before us, I welcome the opportunity to discuss this issue. As someone who sat on the health forum in Galway city for ten years, these figures are not new to me. The appalling fact is that we still have these figures, notwithstanding commitments from government after government. The only light is the report that was published today which will, hopefully, begin to make a difference.

The NTPF, which was to be a temporary measure, was absolutely abused by successive governments, particularly those led by Fianna Fáil. The fund was portrayed as a solution to the problem. We also had the special delivery unit and the co-location initiative from Fianna Fáil and the Progressive Democrats. All of our efforts, as local councillors, went into telling the then Government that this was not the right way to deal with the problem and that there were other solutions. Each time we stand up in here we are accused by other Deputies of being negative. I resent that greatly because we have stood up and repeatedly offered solutions to these problems. In Galway city the Department has been asked repeatedly to listen to what management is seeking, which is to be allowed to go ahead with an options appraisal for a new hospital. We are still waiting for a new accident and emergency department, a project which has not progressed at all. I must pay tribute to a local newspaper, the Galway City Tribune, and urge the Minister to take a trip to Galway and visit the psychiatric unit there. The Mental Health Commission has produced a damning report on the unit year after year. The only answer from the hospital is that eventually there will be a new premises. However, the date for that new premises keeps being pushed out. In the meantime, the psychiatric unit is not fit for purpose. Week after week, as highlighted in the aforementioned local newspaper, the unit has refused suicidal patient after suicidal patient. One such patient was told to take part in the Darkness into Light event. That was the advice given to her as she was turned away. Another person subsequently took his life. I am not going down the road of sharing anecdotes, however. This is a reflection of a dysfunctional system which is a direct result of the actions of various governments to privatise health care, by way of the NTPF, the special delivery unit and so on. The Taoiseach appeared in Galway and said that the accident and emergency department was not fit for purpose. His next trip to the county was to take part in a photo shoot for the opening of an extension to the private hospital. I am quite clear where the Government stands. If there has been a conversion on the road to Damascus as a result of the report of the Oireachtas Committee chaired by Deputy Róisín Shortall, then I pay tribute to her for bringing that about.

Deputy Michael Harty

I would like to address the issue of the waiting lists under the following five headings: recruitment and retention of staff; the lack of bed capacity; access to diagnostics; health service practices and management; and primary and community care manpower. Deputies Kelleher, Louise O'Reilly and I, along with 11 other members sat on the Committee on the Future of Healthcare for 11 months to try to solve this problem. I must say that I am very disappointed that the Minister has just left the Chamber, given that I have been trying to speak to him for over a month on these issues but have not managed to do so.

The recruitment and retention of staff is a huge issue. I speak here about consultants, general practitioners, nurses and therapists. The Irish health system is not an attractive place in which to work. The main problems are working conditions, career progression and job satisfaction. We train the best graduates in the world, allow them to leave the country and then we trawl the world trying to replace them. That makes absolutely no sense.

In terms of bed capacity, anyone who believes there are enough beds in our system should not be allowed anywhere near health planning. We need ICU, coronary care, acute, step-down and long-term beds. The bed capacity review is sporadic but should be continuous. If we have between 200 and 600 patients on trolleys and 400 to 800 delayed discharges, then it is quite obvious we have a bed capacity issue. There is a huge amount of unmet need.

In terms of access to diagnostics, there are difficulties with ultrasound, CT scanning, endoscopy, cardiology and echocardiography. Limiting access to diagnostics leads to unnecessary referrals to secondary care, which clogs up the system in our outpatient and accident and emergency departments. Nowhere is our two-tier system more vividly seen than in access to diagnostics. Rationing access to diagnostics is a false economy and such access is essential if we are to deliver proper health care.

We need to look at the management structures in the health service. We need improved governance and increased accountability. The report of the Committee on the Future of Healthcare is very strong on introducing legislation to make sure we have proper governance, accountability and answerability.

The report that was published earlier today proposes a move from a hospital-centred service to a service that is centred on primary care, including general practice. We cannot do that unless we have enough GPs. If the GP contract is not renegotiated as a matter of urgency, the vision set out in the Committee on the Future of Healthcare's report will not be sustainable.

Deputy Danny Healy-Rae

We have five Ministers and Ministers of State with responsibility for health, and we have any amount of HSE managers, but we do not have a proper health service that treats everyone the same. People who are in pain and in need of procedures are not treated equally. Last Thursday evening - in the middle of the summer - there were 18 people on trolleys at Kerry General Hospital. As I have highlighted on many occasions, people have gone practically blind because they have been waiting two or three years to get cataract procedures. That is not fair or right in any democratic society. We have been told that this can be done much more quickly - in six to 12 weeks - under the Sligo model. Teenagers are having to wait four to five years to get orthodontic treatment. If they are 17, 18 or 19 by the time they get such treatment, their gums have gone too hard. The procedure does not work out and is not a success. On several occasions last year and earlier this year, people waiting for heart bypass surgery at Cork University Hospital were sent home and had to wait for up to five weeks. That is not right. People are waiting for a year, a year and a half or maybe two years for hip replacements.

I would like to mention another anomaly that has been highlighted recently. Many people do not apply for a medical card until they get sick or have to go into hospital. They make an application when a problem arises and wait for four or five weeks for the card to be sanctioned. They have to pay the hospital bills that mount up in the meantime even though they qualify for a medical card. I suggest that in the case of someone who qualifies for a medical card, the card should be effective from the date of application.

Not enough money is being spent on front-line staff. That needs to be addressed. A new building at the Deer Lodge mental health unit in Killarney was built two years ago to cater for 40 patients, but it has yet to be opened. What is happening? I have been told that during Fidel Castro's dictatorship in Cuba, a person who presented with a hip or heart problem could get an operation that week. All the world was giving out about the Castro dictatorship, but it had a better health service than the one we have here.

I thank Deputy Kelleher for giving me this opportunity to raise these matters. The Government needs to get working because the current approach is a failure. Sick people need to be treated urgently.

Deputy Mattie McGrath

Maybe we need to get a dictator over here because there are 660,000 people on waiting lists and 100,000 of them have been on those lists for over a year. We have failed utterly. I am disappointed that the Minister could not stay. I know he is busy. He is canvassing ar an mbóthar. It is nearly all over now. It should be in the bag one way or another at this stage. The Minister is gone. Tá sé imithe. I suppose he will be gone out of his current job next week if the right horse does not get over the fence. He will be like the incumbent Taoiseach, St. Leo, whose mantra with regard to the HSE was "It was like that when I got here". Someone mentioned that he did nothing in the HSE. He just coasted through it. The HSE is out of control. It has no accountability. It is not meaningful to the people. It does not deal with people. It has lost its way completely. It is a dysfunctional organisation. The Minister and the four Ministers of State are all pulling at different bits of it, but they cannot do anything with it. That was evident again this evening when I raised with the Minister of State, Deputy Finian McGrath, the cases of people with disabilities who are waiting to be seen by occupational therapists and specialists. This is criminal. If anyone working privately treated people like this, he or she would be charged with manslaughter.

The hospitals are not clean. They are not being run properly. There is not enough space in them. South Tipperary General Hospital has been operating on a full capacity protocol for 17 months. HSE managers probably spent weeks in rooms coming up with this terminology. They probably had conferences, video-conferences, tele-conferences and mobile conferences in their cars to develop this protocol. I hear people who pull over in their cars and are still in conferences, but nothing is going on. They have protocols for this and protocols for that. They have meetings to decide to have investigations. They commission report upon report upon report, but they cannot have clean hospitals. I suggest we should bring the matrons back to run the hospitals. That would be better than having a plethora of bed managers, ward managers, floor managers, hygiene managers, linen managers and food managers. They have gobbled up and cannibalised a system of decent people. Nurses, doctors and other front-line staff have been hunted. We cannot keep them. The HSE is out of control. It is drifting from crisis to crisis. I do not know who is going to cry "Halt" or say "Stop". It is just not fair to people.

Today - at the height of summer - there are 29 people in South Tipperary General Hospital in Clonmel. We used to call it St. Joseph's Hospital, but that name was banished. Hundreds of thousands of pounds were spent on organising plebiscites in hospitals across the country and bringing artists in to try to get different names to banish the names of the saints. People were afraid that those names might damage them. The hospitals were clean when they were run efficiently by the nuns. Nobody got MRSA. We never heard of it ten years ago. People are now going home to die after picking up this awful illness in our hospital system.

It is time for the Minister of State, Deputy Catherine Byrne, to wrestle with her conscience, if she can find it, and to try to do something. The same thing applies to the Ministers of State, Deputies Finian McGrath and Corcoran Kennedy, and to the Minister, Deputy Harris, who is still in the Department of Health for the time being. I cannot even think of the name of the other Minister of State in the Department. There are five of them. It is like musical chairs. Like the officials, they are passing the buck, passing the package or passing the paper. To hell with the public service people. They are supposed to be serving the patients, but they are not doing so. They are self-serving people. They are interested in promotions and careers. They set up consultancies when they retire on big packages.

An Ceann Comhairle

I advise the Deputy to mind his blood pressure.

Deputy Mattie McGrath

Tá mé beagnach críochnaithe. I am nearly finished.

An Ceann Comhairle

Sit down and mind your blood pressure.

Deputy Mattie McGrath

I hope I will get some hospital to look after my blood pressure. Some junior doctor somewhere else might look after me. He will not allow anybody to do anything unless bedlam prevails. The lunatics are running the asylums.

An Ceann Comhairle

Would Deputy Cassells like to follow that?

Deputy Anne Rabbitte

No pressure.

Deputy Shane Cassells

I will try to match the eloquence that has just been displayed. It is positive that the debate on the Fianna Fáil motion on our health service has focused on solutions rather than on reciting all the problems to the Minister and the Ministers of State, who are acutely aware of the issues that exist. I welcome the Minister's decision to accept the motion crafted by Deputy Kelleher, which seeks a path forward to help people. The Minister's acceptance of the motion must mean much more than platitudes in terms of the reality on the ground for hospitals throughout Ireland. At the end of April, the number of people waiting for inpatient treatment at Our Lady's Hospital in Navan was 434 and the number of people waiting for outpatient treatment was 657. These figures represent an increase of 110%. Tonight's statements will not mean anything unless things change on the ground.

One of the key solutions we are calling for in our motion is the use of outpatient clinic space. We want all ward beds that have been closed to be opened without delay. In the case of my own hospital, there are empty wards where the 24-7 psychiatric ward used to be located before it was moved to a facility in Drogheda. Unbelievably, this move was welcomed last week by the president of Sinn Féin, Deputy Adams, who said it was great to see the ward being transferred to Drogheda. Members of Sinn Féin, like Deputies Adams and Tóibín, might welcome the closure of the units in Navan, but the members of the Save Navan Hospital group and I certainly do not.

The backdrop to the waiting figures at the hospital is even more galling. In the week of the 2011 general election, it was infamously promised in The Meath Chronicle that a new regional hospital for the north east would be located in Navan as long as the people of Meath voted for Fine Gael candidates. This was splashed across the front page of that edition of the newspaper, which I have kept for the last six years. The public voted for Fine Gael and sent the Ministers of State, Deputies English, Regina Doherty and McEntee, as well as the current Senator Butler, to this House, but the hospital they promised would be built and opened has vanished like Brigadoon. The field in which it was supposed to be built has nothing in it but cattle. Calves, rather than little royal county babies, are being delivered in it. The very least we deserve is for Our Lady's Hospital in Navan to be invested in. The extensive campus at the hospital needs to be upgraded and supported so that the 200,000 residents of County Meath can receive quality health care.

An Ceann Comhairle

I think Deputy Mattie McGrath has got something going.

Deputy Eugene Murphy

Follow that.

Deputy Michael Moynihan

How am I going to follow that? I compliment Deputy Kelleher on tabling this motion. There was a "Prime Time Investigates" programme on hospital waiting lists on the second Monday night of January of this year, and for the following two or three days the nation had almost come to a halt over the crisis gripping our health service. Then it faded from the media because there were more sexy comments or programmes and talk of the collapse of the Government, which took the focus away from it. However, the crisis still remains. I have had some personal and political interaction with the health service during the past 12 or 18 months, and with respect to treatment from the cradle to the grave, it is in tatters. What an elderly person going through an accident and emergency department of any hospital has to put up with, and we have heard about a number of those departments in the southern region in the last period, amounts to cruelty in the extreme. I know for a fact that families are thinking twice and three times before calling an ambulance to bring an elderly relative to hospital because they believe they can care for them better at home.

Reference was made to the cleanliness of hospitals. It is a basic requirement to ensure they are kept clean. Some nurses work day and night trying to mind patients in the accident and emergency departments and in other parts of the hospitals, but the system is crumbling. There are queues of people waiting for services in all facets of health. Previous speakers spoke about people waiting for cataract and hip operations and for other treatments. There is talk of the health service improving and of the figures improving, but the health service is not improving. A fine report was published today on the way we will fund our health service for the next ten years, but we must accept that as we approach 1 June 2017, every aspect of the health service is in crisis. What way will it be come 1 November, 1 December or even over next Christmas when it is in crisis now?

The worst part of our health service is the inadequate care being provided for our elderly people. We should be able to provide the best possible care for our elderly people when they need it and are at their most vulnerable, but it is not there. I know of an incident where an elderly man not alone was not able to get a bed but was taken off the trolley and given a seat instead. Is that acceptable? There are five Ministers supposed to be running the Department and there is more money, but is that acceptable? Until such time as someone takes absolute accountability for the service, it will not improve. Taking basic measures would improve it a great deal.

An Ceann Comhairle

Deputies Eugene Murphy, Murphy O'Mahony and Aylward are sharing time.

Deputy Eugene Murphy

There is no doubt there is a serious crisis in our health service. Like other Deputies, every week my clinic is full of people trying to access services. I will cite one example. I am dealing with an independent 76 year old lady who has been waiting for more than 18 months at this stage to have a hip operation, and she is in excruciating pain. I have seen her X-ray and it was shocking to see the state of her hip as she has virtually no hip socket and the pain is unbearable. She may have to go into a nursing home or she may have to have around-the-clock care, and how much will that cost the State? She has waited for the operation and if she does not have it fairly promptly, she will be in serious bother very soon. She recently went to her general practitioner in desperation and wanted to pay privately for the operation with some savings she had, and her family were also prepared to help her. I cannot understand why no one ever directed this lady to the cross-Border health care initiative. She could avail of the operation in a private hospital in the North and she could claim the money back. There seems to be no emphasis on that initiative and that should be examined. It should be developed and promoted more. It is not being advertised. I do not know the reason for that. It appears that the consultants do not want it to work. That is my view.

We can talk about the figures. Some 10,900 - almost 11,000 - children are on hospital waiting lists, 4,600 of whom have been on them for more than 18 months, and 46,000 people have been waiting for 18 months to see a consultant. It is horrendous. The inpatient figures for University Hospital Galway are 11,000. We have to tackle this problem. It is getting worse. Our people have little or no faith in the health system. It is to be hoped this motion will move matters forward and we will see an improvement in the system in the very near future.

Deputy Margaret Murphy O'Mahony

I compliment my esteemed colleague, Deputy Kelleher, on tabling this motion. I ask the Ceann Comhairle to allow my colleague, Deputy Aylward, to contribute and we will be as brief as possible.

The programme for Government provides that continued investment of €50 million per year would be made available to reduce waiting lists and overcrowding, particularly for urgent cases and for those who have been waiting longest, yet more than 660,000 people are on hospital waiting lists. Alarmingly, this represents a steady increase of approximately 30,000 since last February. Aside from the distress these long and protracted waiting lists have on patients and their families and the impact it has on their medical conditions, there is also the knock-on effect waiting lists and overcrowding have on day-to-day treatments and procedures, especially if emergency departments are only dealing with overcrowding and emergency situations. There is no doubt that making more facilities available at primary care level would help alleviate the pressures experienced in hospital waiting rooms and emergency room, ER, departments. However, it also needs to be noted that extra resources afforded to general hospitals would certainly ease the burden on the larger university hospitals. For example, I know that if progress were made on a rehabilitation unit and an endoscopy unit for Bantry General Hospital in Cork South-West and if those facilities were in place, there would be no need for many patients to attend various Cork city hospitals for such treatments. Efforts to address waiting lists and overcrowding should be all-encompassing and segregating inefficiencies in the health system will prove to be counterproductive in the long run.

Deputy Bobby Aylward

My colleagues adhered to their time allocation and I thank them for the time they have allocated me. I wish to raise the issue of University Hospital Waterford. I understand the mobile cath lab is due to come on line this summer to help alleviate the cardiac waiting lists in the south east. Will the Minister of State update us on this? I received confirmation from the Minister, Deputy Harris, via a parliamentary question, that the new mobile unit will focus on the outstanding waiting list for diagnostic angiograms. That concerns me as more people will be diagnosed more quickly but the current facility will have limited extra capacity to carry out follow-up procedures resulting from these additional angiograms. I understand an additional €500,000 has been allocated in line with a recommendation of the Herity report to provide an additional eight hours' cath lab activity per week. That is not enough.

It is projected that 30% of patients would require additional procedures while it is anticipated that a total of 1,500 diagnostic procedures could be carried out in the mobile lab annually. This would result in an additional 450 extra people being added to the waiting lists for cardiac procedures at the existing cath lab at Waterford hospital each year.

All this deflects from the overarching need for a second permanent cath lab, working 24 hours a day, seven days a week, and that is the main issue. There is virtually no change to the current situation in the south east where we have no provision for cardiology cover at 5 p.m. every weekday and no availability at all at the weekend. We need 24-7 cardiac services in the south east.

I know my time is up but I also want to mention the National Treatment Purchase Fund, NTPF. It is more than a year since we have had the confidence and supply agreement and yet not one person has been treated through the NTPF.

I also have serious concerns about the National Rehabilitation Hospital and people with brain injuries are waiting on beds in that hospital. I know of two or three patients who are waiting on beds there and I cannot do anything for them. I am in constant contact with the hospital and I have still had no results for them.

The Scoliosis Advocacy Group was founded by two great ladies from Kilkenny, and we have been told of the Government's commitment to a four-month maximum wait time for scoliosis surgical treatment, yet parents were told last week that the waiting lists remain at 18 months. No progress has been made.

Those are the questions that need to be answered and that we need to debate tonight. I thank the Ceann Comhairle for allowing me that time.

An Ceann Comhairle

I advise the parties not to submit unrealistic lists of speakers and times in future. While we have taken them tonight, we will not be taking them in the future. I call the Minister of State.

Minister of State at the Department of Health (Deputy Catherine Byrne)

I apologise on behalf of the Minister who could not remain in the House for the debate as he had other business to which he had to attend. I advise Deputy Mattie McGrath that I and many of us have a conscience and that is why we are here debating this issue. On behalf of the Minister, I thank the Members who raised this matter for their considerate contributions. It is clear from the debate that the House shares the Minister's commitment and determination, and that of the Government, to do better for our patients.

As the Minister for Health mentioned earlier in the debate, the cross-party Oireachtas Committee on the Future of Healthcare published its final report today.

This is indeed a seminal moment on our path towards improved health services in Ireland. I take this opportunity to commend the members of the committee on the exceptional contribution of time and effort to this endeavour during the past year.

We are living longer and are healthier than ever before, and this is something to be celebrated. However, it also means that there are increasing demands on our health care resources. The Government is aware that if we are to break the vicious cycle of overcrowding and long waiting lists in our hospitals, we need to put in place the fundamental building blocks for our health service. I am confident that the recommendations put forward by the committee will help steer us in the right direction and I look forward to the upcoming debate on the report in June.

I now wish to return to a couple of items in the Fianna Fáil motion that the Minister did not have the opportunity to cover in detail. With regard to better utilisation of hospitals without 24-7 accident and emergency departments for the purposes of elective surgery, this proposal is also in line with the plans currently being implemented by this Government in respect of hospital groups. Hospitals are now starting to work together to support each other, providing a stronger role for smaller hospitals in delivering less complex care and ensuring that patients who require true emergency or complex planned care are managed safely in larger hospitals. Each hospital group will be required to develop a strategic plan to describe how it will provide more efficient and effective patient services while reorganising these services to provide optimal care to the populations it serves. In this way, there is a strong role for smaller hospitals, in which they will provide more services, not less. The challenge is to ensure that they provide the right type of services, which can safely be delivered in these settings, in order that we maximise the benefit to patients.

The Fianna Fáil motion also refers to increased utilisation of community hospitals. The priority of the Minister for Health is to ensure that older people get the best care possible. For many, that care can be provided in their own homes and communities. Community hospitals are an essential part of our national infrastructure of public nursing homes, providing a mixture of long-stay and short-stay care. These short-stay beds include step-up and step-down care, intermediate, rehabilitation and respite care, which are used in a flexible manner to meet local needs at any given time. This relieves pressures, particularly in the acute sector, by preventing unnecessary admissions to hospitals and facilitating timely discharge. They are also essential to ensure older people can be cared for in their local community. GP access to these short-stay beds maximises the efficient usage of these beds as well.

Many public units are housed in buildings that are less than ideal in the modern context but, notwithstanding this, the care delivered to residents is generally of the highest standard. It is important, therefore, that we consolidate our existing stock and this is the aim of the five-year capital programme for community nursing units announced last year. This provides the framework to allow for an enhanced programme to replace, upgrade and refurbish these care facilities. In this regard, although improving hospital services is essential, we cannot underestimate the importance of moving away from a hospital-centric model of care and understanding the interrelated, interdependent nature of the environment within which public hospitals operate. A Programme for a Partnership Government contains a commitment to a decisive shift towards primary care so that better care, close to home, can be provided for in communities throughout the country. The Government wants to develop and expand the capacity in primary care in order to encompass health promotion, prevention, early identification, simple and early interventions, as well as patient empowerment. This proposed expansion in the range of services and capacity available within primary and community care can help to keep people well and minimise, as far as possible, the number of patients admitted to hospitals in the first instance.

We also need to intensify our efforts to invest in our health and well-being and tackle the rising trend of chronic disease. The Healthy Ireland framework provides the overarching context for the health strategy of the future and, as such, is the blueprint for the ongoing broad range of work taking place across Government aimed at shifting our focus more to population well-being and disease prevention, as well as reducing health inequalities. Earlier this month, the new brief intervention model, Making Every Contact Count, was published by the HSE. This approach recognises that among the 30 million contacts our population has with the health services annually, there is an opportunity to effect behaviour change if necessary, focusing on the four key areas of tobacco use, harmful alcohol consumption, physical inactivity and unhealthy eating. Implementing Making Every Contact Count in all parts of our health service will be a significant step towards achieving that fundamental shift to prevention, health promotion and patient empowerment required to achieve a healthier Ireland.

I know we all wish for a better health service and improved hospital services. I assure my colleagues that this remains a priority for the Government and that we will continue to work hard and stay focused on this issue. I have taken a number of notes from some speakers and will raise the matters with the Minister, particularly those regarding different hospitals around the country.

An Ceann Comhairle

I thank the Minister of State very much. That is appreciated.

Deputy Niamh Smyth

I commend my colleague, Deputy Kelleher, on putting forward this motion as provision of quality, yet affordable, health care is one of the greatest challenges facing our society. Patients seeking medical care expect to be met with delays of a reasonable time but for latitude to be stretched over a series of months and even years, with little to no treatment, care or assurance is simply not acceptable. My party and I are exasperated by the lengthy times patients spend on waiting lists but our concern is only eclipsed by those on the list who must deal with the shortfall in our national health care system. The steady upward trend of those waiting for medical attention is indicative that our health care system is operating neither effectively nor at capacity.

In my constituency, Cavan General Hospital has experienced a 236% increase in the number of people on outpatient waiting lists waiting 12 or more months for appointments between April 2016 and today. That means there are 2,350 people on outpatient waiting lists, while national figures are even more appalling. At the end of April, 654 people were waiting for inpatient appointments, 115 more than at this time last year. What will it take for the Government to address these shortfalls in our health care system? These incredible delays mean that anguished patients in our constituencies have to manage for months and even years on end. We must take steps to amend the capacity shortfalls in our health service before another patient falls victim to such inadequacies.

Many of my constituents cite incredibly long waiting times for procedures such as hip and knee replacements, cataract surgeries and other causes of concern. Patients in need of hip and knee replacements must give up active lives and turn to being inactive. I am conscious of the time but I would appreciate if the Minister of State could reply on some of the matters I raised.

Deputy Eamon Scanlon

I thank Deputy Kelleher for tabling this motion for discussion. There is no question but that the matter to which it relates is very serious. I have listened with interest to many previous speakers. I had intended to say something different but I will read into the record an email I received today, 30 May 2017, at 2.31 p.m. It states:

Hello Eamon. I am getting in touch with you on behalf of my husband. His name is [...]. He is 72 years old and is waiting on a heart procedure to be done in the Mater hospital. The procedure my husband is waiting to have is called a pulmonary vein isolation. He was up there in the Mater in January for assessment and he was told there is a two-year waiting list but because of his urgent situation, they would try to get him seen to, hopefully within six months. I am told today that is not going to happen now.

This woman is very distressed and disappointed. She continues:

I hate having to sit by and watch my husband deteriorate. His respiratory consultant told him he would have to come off heart medication as it is impacting very negatively on his breathing and lungs but his cardiac consultant said, no, he cannot come off heart medication as it is keeping him alive until he has this procedure done. I am begging with you and imploring upon you to please help me to help him have this procedure done as soon as possible. We are ordinary people who have worked hard all our lives but could not afford private health insurance any more.

They are on their own. The woman concludes, "We would be prepared to travel anywhere in Europe as long as he can get this done soon."

I could bring in 25 more of these emails. I have another case of a lady with a 3-cm aneurysm in her brain waiting for an operation in Beaumont Hospital. If it reaches 5 cm, it is over. This lady is 42 years of age. This is what is happening in the real world. We can criticise the National Treatment Purchase Fund and everything else but it worked when it was in operation. These people are waiting and if they can avail of it, lives will be saved. It may be happening already - I do not know as I am not a doctor or consultant - but if something is not done very soon, people will die waiting.

Deputy Anne Rabbitte

I compliment Deputy Kelleher on tabling the motion. Like my colleagues, I too feel very strongly about the lack of usage of the National Treatment Purchase Fund of which there was criticism while it was in operation. I note the Sinn Féin Member is leaving and that Sinn Féin spoke earlier about being anti-privatisation. As Deputy Scanlon has just said, parents and families do not mind once they get access to the services.

Believe it or not, Galway Hour on Twitter is covering these proceedings as we speak. At this minute, people are talking about tonsillitis and children who saw consultants last July but still cannot get appointments to get their tonsils out as we head into the month of June. Children are suffering infection after infection. This is just one snippet of many describing what is happening. A number of people call into my clinic regularly to discuss cataract procedures. They wait for over two years and are told they will be lucky to have the procedure done in the next year and a half. Another example I have in front of me concerns osteoporosis and access to the DEXA machine in Galway. This time last year, there was a 20-year waiting list for people to get their bone density checked. This is the real world we face day in, day out. If we could access the National Treatment Purchase Fund and get people off these lists and bring them down to a manageable level, perhaps we would have fewer debates about this.

Deputy Billy Kelleher

I welcome the contributions of all the Deputies who contributed but I am very disappointed not more groups took time to speak on this important issue. Not only in the context of my motion but in health debates in general, there has always been a strong element of robust debate and analysis in this Chamber. However, it is quite incredible that we could not fill the full allocation of two hours this evening.

The motion was tabled because we must consistently highlight the deficiencies and inadequacies in our health service. Deputy Eamon Scanlon, for example, highlighted a genuine, real case, one of the 660,000 people out there on waiting lists. The motion was tabled with that purpose in mind and also to come up with some observations and solutions in the area of health care. We need to increase the times during which diagnostic tests are available across hospitals. We must move to a system of provision from 8 a.m. to 8 p.m., seven days a week. We need to ensure the wards that are closed are opened up. We talk about a lack of beds and bed capacity reviews but, at the same time, wards close simply because we cannot retain or recruit enough nursing staff to populate them. Even within the current crisis, there are solutions that may resolve some of the problems to which the Deputies referred in the context of individuals waiting inordinate periods for diagnostics, operations or procedures. It is within the Government's gift to do these things; it just needs a little honest commitment, a bit of backbone and a Government willing to consider the challenges out there and try to resolve them step by step.

We have listened to lectures from those who oppose the National Treatment Purchase Fund. I have no ideological view as to whether the National Treatment Purchase Fund is right or wrong. My only view is that it does benefit those who are waiting inordinate periods on the public waiting lists. It drove down waiting lists over a protracted period and it was a positive initiative. Those who support Maduro and Stalinist parties can have their views but I simply suggest that in the meantime, while our public hospital system does not have the capacity to deal with what is presented to it daily, the National Treatment Purchase Fund is a solution in the short and medium term while we wrap up capacity in our public health system.

In the motion, we highlight the deficiencies and come up with sensible suggestions which, I believe, the Minister of State and her colleagues can, with a small bit of imagination and grit, resolve. I ask her to consider, for example, the area of diagnostics. Day in, day out, there is not a Deputy in this House who does not table a Dáil question about someone attending his or her clinic or advice centre who simply cannot get a diagnosis. These people are waiting years to get diagnoses. They do not know what is wrong with them. The doctor or general practitioner will write a referral stating the matter is urgent; six months or a year will pass; there will be delays, prevarication and cancellations. Last year alone, 36,000 operations were cancelled in the public health system - 36,000 people who had in their own mind been prepared for an operation and it was cancelled. I have dealt with cases of women who were scheduled for double mastectomies and gowned up in a hospital but whose procedures were cancelled at the last minute. That is what is happening out there. I do not wish to be alarmist, but we have an obligation and a duty to come up with solutions. If we do not accept first of all that we have massive problems, as identified by my colleagues this evening, we will consistently go on the merry-go-round of pretence and spin while 660,000 people languish on waiting lists and 350 or 360 people a day languish on trolleys. It is a sad indictment on everyone but it is the Government's turn now to come up with some of the solutions and to address some of the inadequacies. Tonight's motion, in the context of the issues I have highlighted, would make an impact on some people's lives if the Government acted upon it. I commend the motion to the House.

Amendment put and declared lost.

Motion agreed to.

The Dáil adjourned at 9.48 p.m. until 10 a.m. on Wednesday, 31 May 2017.

Dáil Éireann debate - Tuesday, 30 May 2017

Hospital Waiting Lists: Motion [Private Members]

Dáil Éireann debate -
Tuesday, 30 May 2017