Seanad Éireann debate -
Thursday, 27 Nov 1997

Vol. 152 No. 16

Adjournment Matters. - Hospital Waiting Lists.

Mr. Costello

Hospital waiting list numbers are showing a sharp increase. There are now approximately 30,000 people on hospital waiting lists. Approximately 10,000 of them have been waiting longer than the Government's maximum target of 12 months, and 50 per cent of children on those waiting lists have been waiting for treatment for more than six months.

The Mater Hospital has a current overrun of £1.6 million. It has had to close 20 beds and its CAT scan system to save money, and it has the largest number of people on its waiting lists in the country. The Minister for Health and Children has introduced a supplementary budget, which is to be welcomed, but I am concerned that much of that supplementary budget will go to health boards and various hospitals, where it is unlikely to make a serious dent in waiting lists.

The Minister of State will remember that when Deputy Brendan Howlin was Minister for Health in 1993, there was a co-ordinated, phased programme to reduce hospital waiting lists. When £50 million was allocated specifically to that purpose, there was a consequent benefit in the 30 per cent reduction of numbers on the waiting list. Now the numbers are increasing again, and the problem is becoming very serious.

It is believed that 20 per cent of coronary patients die while awaiting bypass operations. The waiting list problem faces the elderly and the youth. In 1992, Dr. John O'Connell produced a patients' charter while Minister for Health which stated that everybody, irrespective of income, would have access to high quality medical care. He specified the elderly, children, those with mental or physical disabilities and expectant mothers.

We now face a problem that is getting worse and we do not appear to have a coherent programme to deal with it. I am worried that the situation will worsen and that the numbers on the lists will increase. The Minister received a report from the advisory group on materials management for the health boards and hospital services. It indicated that approximately £30 million could be saved if there was a more co-ordinated approach to the tendering and purchasing of stocks and supplies. What has the Minister of State to say about that report?

There was a recent newspaper report relating to the President of the Irish Pharmaceutical Healthcare Association which concerned me. The president condemned a practice that the health boards are operating whereby general practitioners have made savings on medical cards to the amount of £30 to £40 million. They are doing so by prescribing generic drugs rather than top of the range designer drugs. An incentive is being given to general practitioners to keep 50 per cent of the savings to improve their practices. This would not be tolerated in the private sector, where a private patient would be expected to pay over the odds for top of the range drugs which are not necessarily better than a generic drug which could be prescribed at a much lower cost. Various schemes and refunds benefit the private patient, however, and the taxpayer picks up the tab for designer drugs. It is appalling that the President of the Irish Pharmaceutical Healthcare Association can make such remarks, and the Minister should respond to them. Anything that can save money for the taxpayer in this area is very desirable as long as it does not interfere with the health service.

There is a problem with hospital consultants. The Buckley report indicated a link between hospital costs and the activities of hospital consultants. Those consultants should be integrated into the management of hospitals, as that might reduce costs. Consultants' services and salaries are matters of concern.

I experience these problems in my constituency in relation to the Mater Hospital, which is having serious problems, and Temple Street Children's Hospital, which is in a deplorable condition. It must be replaced and not refurbished. Conditions there are Dickensian, and although a wonderful service is being provided, it is not satisfactory. Enormous investment and work are necessary, and the Minister of State should indicate what steps are being taken to reduce the waiting lists.

Minister of State at the Department of Health and Children (Mr. Fahey)

The Senator will be aware that between 1993 and the end of this year £58 million has been provided for the reduction of waiting lists for hospital treatment. When the waiting list initiative commenced in June 1993, there were 40,130 on waiting lists for hospital treatment. By the end of June 1997, this figure had been reduced by 9,677, or 24 per cent over three years.

In 1997, £8 million was set aside to continue the work of reducing waiting lists. This funding was targeted at areas where waiting times for surgery were excessively long and special attention was again paid to reducing the waiting times for cardiac surgery, including heart bypass operations. This represents significant progress in the reduction of waiting lists and demonstrates the Government's concern that the necessary resources are provided to improve waiting times for treatment.

I will shortly be notifying health boards and hospitals of revised arrangements for implementing the waiting list initiative in 1998. Among the primary steps to be taken for 1998 will be: agencies will be notified of their waiting list funding shortly. This will be much earlier than in previous years and will enable them to plan their waiting list work accordingly during 1998; hospitals will be required to structure their services to ensure that, over a period, there are no adults waiting for more than 12 months and no children waiting for more than six months in targeted specialities. This will obviously take some time to achieve but the objective of eliminating waiting times over this period should be clearly stated. It will involve agencies planning carefully the level and type of activity to be carried out; where it has not already done so, each agency will be asked to designate an individual to co-ordinate waiting list work. This is aimed at ensuring that all the arrangements relating to planning and delivering waiting list services are done in an effective and co-ordinated way. The emphasis will be on obtaining value for money and on catering for patients in the most efficient and sensitive manner possible; the importance of validating waiting lists will again be emphasised, in order to ensure that my Department has an accurate and up-to-date picture of the overall situation.

As in previous years, attention will continue to be paid to waiting times as well as numbers on waiting lists with the objective of ensuring that children do not have to wait longer than six months and adults no longer than 12 months in the specialities targeted for attention. As part of the revised arrangements for 1998, the Minister will shortly commission an independent evaluation of the waiting list initiative to examine how it has performed and to identify other possible areas of improvement and development. I am confident that hospitals will continue addressing the issue of waiting lists and waiting times and that, using the resources made available to them, they will make good progress in this important area.