Hospital Waiting Lists: Motion

I am informed that the proposer of the motion is en route to the Chamber. I will allow a few minutes for her to arrive, and if she is further delayed, we will propose the suspension of the sitting.

I apologise for being late.

I apologise to the Acting Chairman and to the Minister for being late.

No problem. It could happen to any of us. We are dealing with No. 29, motion 16.

I move:

That Seanad Éireann:

recognising that:

- 632,000 patients were on published and unpublished hospital waiting lists at the end of January 2017;

- 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;

- 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; and

- 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;

notes the success of the integrated IT system used in the Portuguese NHS 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 waiting lists for surgery have decreased by almost 35 percent, the median waiting times by almost 63 percent and variation across providers is also diminishing;

and calls on the Minister for Health to explore the feasibility of a new model to maximise the capacity of the public hospital system, purchase capacity from the private 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 public and participating private hospitals;

- 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 public or participating private hospital; and

- an end to the special treatment of private patients in public hospitals.

I thank the Minister for coming to the House. I apologise again for being late. This Sinn Féin motion puts forward a radical and pragmatic proposal to develop a new comhliosta model to maximise the capacity of the public hospital system to purchase capacity from the private system at a reduced cost and to introduce fairness and strategic management across all waiting lists.

Many Senators stood in this Chamber after the "Prime Time" programme which highlighted the scandal and inhumanity of people waiting in pain for medical treatment. They expressed their horror at a failed health system which was not fit for purpose. Today, Sinn Féin is presenting those same Senators with an opportunity to instruct Government to explore the feasibility of a new single integrated hospital waiting list management system to cover all public and participating private hospitals. Today, we will see if there are expressions of horror or just empty words, or if they can put party politics aside and support a new model which has delivered significant and sustained reductions in waiting times for surgery since it was first introduced in Portugal in 2004.

Sinn Féin had prioritised the issue of fair and transparent waiting lists long before the latest controversy surrounding inaccurate figures from the National Treatment Purchase Fund surfaced several weeks ago. It is also part of our response to the many problems facing our society to have workable and costed solutions that can be implemented at once. My colleague in the North, Michelle O'Neill, has recently sought cross-party support for the implementation of the Bengoa report which will see £31.2 million invested to clear the backlog on waiting lists in the North. All of this progress in health in the North is taking place in the midst of a political crisis within the institutions and on the back of years of brutal Tory austerity. Sinn Féin can deliver on health and is currently delivering under very difficult circumstances.

An all-island approach to health not only will benefit future patients but also holds the key to tackling regional imbalance in waiting lists. On Monday, Michelle O’Neill was joined by the Minister for Health, Deputy Harris, to open a cross-Border regional radiotherapy unit in Altnagelvin Area Hospital. This unit serves the north west of the island and now means that patients in Donegal, Derry and Tyrone can access cancer care within one hour’s travelling distance of their home. Once again, a genuine all-island approach is delivering real results for those most in need.

The comhliosta system we have proposed in this motion is in response to a plethora of announcements and promises by this and previous Governments that have at best delivered temporary and sometime illusory results. First, there is undeniably a two-tier health system which starts at the access point to care. This system involves the provision of a core activity budget to public hospitals. This would be based on the previous year's activity adjusted for inflation and any successful proposal made for a portion of the increased funding made available under Sinn Féin’s growing health budget. Increased capacity for the public health system is urgently needed. The recruitment of further consultants, in particular, would significantly reduce waiting times for initial consultations and the wider measures to tackle hospital overcrowding would shorten the second portion of waiting times, as a greater volume of elective procedures would be facilitated.

Sinn Féin wants to see an end to the special treatment of private patients in public hospitals by incrementally eliminating private activity and replacing the revenue lost with increased public funding to their core activity budgets during a term of government. According to the 2015 HSE financial statements, in 2014 the statutory public hospital sector got €298 million from private patients. This figure does not include the voluntary hospitals and no figure for that sector was provided in response to parliamentary questions tabled by Sinn Féin. However, the HSE estimated in its 2014 submission to the consultative forum on health insurance review group that "the Private Health Insurance market generates roughly €500 million per annum for the statutory and voluntary hospital system". Sinn Féin would make an additional investment of €100 million, rising to €500 million annually, for the core activity budgets of public hospitals to replace the revenue streams from private insurance.

Under the current system, waiting lists for outpatient appointments, diagnostic tests, day case and inpatient procedures vary drastically from one public hospital to the next. Patients do not know where they stand on the list nor at what speed their list is moving. People with comparable health concerns can wait very different lengths of time for assessment and treatment depending on what hospital they happen to be referred to initially.

We would introduce a version of the integrated IT system used in the Portuguese national health service, NHS, which would help to achieve new maximum wait times by actively transferring those on the list from hospitals that are failing to meet the target to hospitals that have the ability to offer the service on time. The new maximum waiting times should be developed to cover the entire period from referral to the end of the episode, that is, the time when either a decision is made to treat or not to treat a patient. The IT model introduced by the Portuguese, alongside greater investment in public hospitals, has delivered significant and sustained reductions in waiting times for surgery since it was introduced in 2004.

As described in the 2013 OECD publication, Waiting Time Policies in the Health Sector: What Works?, over five years waiting lists for surgery have decreased by almost 35%, the median waiting times by almost 63% and variation across providers is also diminishing. When a registered patient has reached 75% of the maximum waiting time allowed for their treatment, a voucher is automatically generated allowing the patient to obtain treatment in a different public or participating private facility. The payment is the same regardless of the status of the provider. Unlike the National Treatment Purchase Fund, in which we no longer have any confidence, fees for comhliosta activity would be centrally determined and set at a rate below that paid for core activity, which must take account of all hospitals' fixed costs. In Portugal, the additional surgeries conducted via the transfer system cost on average 70% of the price paid for basic surgery provision.

Hospitals in Portugal have an incentive to engage in additional transfer activities over and above that contracted to attract the 70% funding which comes to them. Almost 80% of Irish consultants are currently engaged in some form of private patient activity outside of their contracted hours. This shows they have the capacity to carry out more public activity, which would allow us to treat everybody quicker, as well as on the basis of clinical need alone rather than patient status. Coupled with greater public investment, comhliosta could do just that.

Sinn Féin would seek to achieve public-only consultant contracts covering core activity on a full-time or part-time basis. Contracts would include protected time for teaching and facilities for research and academic collaborations. Further income could also be generated by consultants by undertaking additional activity transferred to them by comhliosta outside their contracted hours.

The plight of over 600,000 people waiting for hospital appointments means a fresh approach is needed to deal with these lists. The disparity of waiting lists between east and west is shocking. In UHG, University Hospital Galway, 1,093 people were waiting for over 18 months for appointments. The nearest in the east was Beaumont Hospital with 448 patients waiting. While there are over 600,000 people waiting nationally, the crisis is more severe in the west. As of the end of last month, in Mayo University Hospital, 53 people were waiting over 12 months for treatment while in University Hospital Galway, there were 2,190 people.

Comhliosta will provide for patients to be moved from one hospital to another to reduce pressure on those hospitals. Sinn Féin sees this extending to the entire island. From the implementation of the report in the North, Daisy Hill Hospital could take patients on waiting lists at Our Lady of Lourdes Hospital, Drogheda.

Our Private Members' motion is a positive effort to improve waiting times for patients and to provide clarity and fairness around the process. It is not a dig at the Government. It admitted there is a problem and also accepted that the manipulation of figures serves nobody, least of all the patients.

This current crisis did not start in 2011 with the current Government. In my area, Belmullet Community Hospital had 20 of 40 of its beds shut in 2009 under the Fianna Fáil Government, implemented by a Progressive Democrats Minister, Mary Harney. The reduction in beds at community hospitals was matched by a savage cut in home help hours. In Mayo alone, between 31 August 2009 and 31 August 2010, 32,000 home-help hours were cut. This left many vulnerable people with substandard care and meant they ended up in major hospitals.

I was shocked to read in the Irish Medical Times earlier this month Senator Keith Swanick calling for the expansion of community hospitals. He cited Belmullet as an example, where he correctly stated the nearest acute hospital is over 50 miles away. In that same article, he said, "The community hospital network should not be seen as a relic of a bygone era." Against the wishes of the whole community of Erris and Mayo, his own party, Fianna Fáil, cut half of the beds in Belmullet Community Hospital. Are we now to believe he and his colleagues will rescue all community hospitals?

It is this type of hypocrisy from Fianna Fáil which has the health system in its current crisis. Fianna Fáil now extols the virtues of further investment in the vital services that it stripped bare of cash when it was in power. I will not allow this go unchallenged. A community hospital in my area, providing step-down and respite care, was shut down to satisfy the neoliberal privatising agenda of Fianna Fáil and the Progressive Democrats. Between 2007 and 2011, Fianna Fáil cut 1,274 acute beds and 1,123 long-stay beds, as well as hundreds of thousands of home-help hours. Are we to believe Fianna Fáil is now the party to solve the crisis it designed and delivered? I find it pathetic that Fianna Fáil saw fit to put forward a so-called amendment to a genuine attempt by my party to address the reality of this serious problem.

Our motion calls for increased investment in recruitment, vital to clearing waiting lists. Between 2008 and 2015, the health service lost 7,377 workers.

This motion was a genuine attempt to offer a solution to the current inhumane problem we have with hospital waiting lists. For Fianna Fáil to put down a nonsensical amendment to dirty the waters is disingenuous beyond belief.

I call Senator Máire Devane.

It is Devine.

Quelle surprise with Fianna Fáil's amendment. We are used to it at this stage. It is a good way for it to keep sweet with both its friends and foes.

Our comhliosta proposal would see immediate improvements for those people on long-term hospital waiting lists. It is an unfortunate fact that if people access the public health system, they will more than likely feature on two lists which are often referred to in this Chamber. If they go to accident and emergency, they will likely be a part of the trolley figures released daily, not by the Government but by the Irish Nurses and Midwives Organisation. It has been eventually conceded by the Government that the INMO's figures are correct. Today, the total number of patients on trolleys is 425. It has reached 600 at different times and not just because of the influenza virus.

If these patients are lucky and get a bed and an assessment, they may be referred to a specialist or a consultant who will then prescribe a necessary and often life-saving procedure. It is then they will feature on the National Treatment Purchase Fund, NTPF, published waiting lists.

While all this bureaucracy is ticking along, people with suspected serious conditions are left to worry as the weeks pass by if their condition is worsening and if the passing time is reducing their chances of a successful recovery. As the Minister knows, when people become ill, their job is at risk, their finances decrease and their well-being is affected. They are left to languish at home with nothing to do, only worry when their procedure will happen, whether it will be successful or whether they will expire in the meantime.

An example of this process is the amount of time people spend waiting for mammograms. Early diagnosis is vital and I commend the successful BreastCheck programme. A friend of mine who is under 50 was referred by her GP for a lump on her breast. She was told by St. James's Hospital that it will be 26 weeks before she is seen. I have had someone table a parliamentary question to find out why there is such a long waiting list for such a serious illness.

Sinn Féin's system would have patients enter the waiting list at least at the point of referral for treatment by a consultant specialist. As the budget for comhliosta would grow, we would want to see the patient enter the system at the point of referral by a GP. The system would be freely accessible to patients online where they could monitor their position on the list in real time. After 75% of the target time has elapsed, they will have the option of using a voucher to seek treatment in the private health care sector or from a public hospital if it is not experiencing the same pressure on its waiting lists.

More resources and staff are needed to meet increasing needs. However, making improvements is not just about money. Changes mean senior clinicians should admit and discharge patients. It means making the health system attractive to recruit and retain high-calibre staff. It requires more and better access to diagnostics and treatment outside of hospitals, often in primary care centres, delivered by GPs and nurses. This involves resourcing primary care. It means doing what is currently not being done.

Over a decade of pouring hundreds of millions of euro into the NTPF is proof that it does not address the underlying causes of the long waiting times for public patients in the first place. This week's revelations show the waiting times for public patients, as articulated by the NTPF, have not been accurate in the first place.

The issue of mental health waiting lists has barely been touched on in this debate. My colleague, Deputy Pat Buckley, recently received information from the Health Service Executive, HSE, regarding waiting lists for mental health care for adolescents in the southern region. The figures were shocking. Compared with the rest of the country, they are 50% higher in that region and we need to find out why. We know of the anguish of parents and young adolescents having to wait for a consultation or counselling for up to 20 weeks.

In the meantime, most of them deteriorate mentally and feel unsupported, as do their parents.

The figures shine a light on the gaps in mental health services and supports for children, including staff shortages in child and adolescent mental health services. Mental health is an area in which successive Governments have struggled to provide an adequate level of service. This is an issue that Sinn Féin has highlighted continually in the Dáil through parliamentary questions and through representations to the HSE. In our Better4Health document launched last year, Sinn Féin put forward ten proposals to ensure mental health care is prioritised. A 24-7 service was voted down, not only by the Government side but also by our friends in Fianna Fáil.

Access to mental health services for children and young people is clearly severely restricted when one considers the current waiting lists. A cursory glance at the figures shows that mental health care for this cohort is not being prioritised as it should be, not just because of the existing waiting lists but also because of the staffing levels in the community.

Our comhliosta proposal formed part of the Better4Health document which we launched last year. Senator Colm Burke has not taken an opportunity to look at it. When my colleague, Deputy Louise O'Reilly, pressed the Minister or the HSE on the need for a new single integrated hospital waiting list management system, she was met with refrains that it is one option presented as part of a digital package solution, but we are no clearer on the Minister's intention to bring this forward. The HSE argues, according to documents, that €1 million would be sufficient to advance this. The Minister would be better off investing public funds in this type of new system and the digital solutions required to modernise our health service rather than relying on the questionable National Treatment Purchase Fund, NTPF, figures which have demonstrated that fund's inability to be transparent and its management of waiting list figures. Investment in developing capacity in the public health system would be more beneficial in the long term.

The Minister has our proposal in writing and he refused to meet us on several occasions. In e-mails dated 17 and 30 August and 16 September last year, the Minister's office fobbed us off with excuses on waiting list initiatives and when we requested to meet to discuss our proposal.

There is a Committee on the Future of Healthcare, with which Senator Colm Burke has close contact and on which he has a heartfelt need to be, but it has become clear that the five point plan has failed in this regard. The Minister should actively look at the solutions we have presented to him. The Minister should also make the process more transparent. What are the digital package solutions the Minister has used as a stock response to many of my party's suggestions? What progress is the Minister making on this? What investment is needed? Can we have an update on this? We have not received one to date. The matter is not being given the attention it deserves.

I welcome the Minister to the House. I thank the Sinn Féin Senators for bringing forward this motion. It is an important debate. I also thank the Fianna Fáil Senators for bringing forward their amendment because it is by debating and coming to agreement that we can progress the difficulties in the health system.

There is a major problem with figures and I do not like the impression being given that the whole health system has come to a full stop. It implies there are 100,000 staff not working. I have given the figures and I will repeat them. There are more than 65,450 attendances in outpatient clinics every week. I checked the most recent figures available. Some 1.3 million go through accident and emergency per annum, which works out at 25,000 a week. There were 879,000 day case procedures in 2015. This is the 2015 figure because I do not yet have the 2016 figure. Therefore, there were approximately 16,900 day case procedures per week. Overall, there are more than 100,000 patients going through the health system in one way or another every week other than the number of patients who are in hospital at any one time. In addition, there are another 23,500 in nursing homes under the fair deal scheme and there are community hospitals. We are delivering a service.

I agree with my colleagues that there are many deficiencies and they have been allowed to build up over a long number of years. It is not something that has happened overnight.

On the waiting lists, while 58% are waiting less than six months, the figure for those waiting less than six months is still too low. People should be able to get access at the earliest possible time. In fairness to the Minister, €20 million is allocated this year for the National Treatment Purchase Fund, NTPF, with €55 million for 2018. I am not convinced that the NTPF, in the way it is structured at present, is the way forward.

For instance, in Cork, we have a long waiting list for gynecological services. The question of how that was allowed to be created needs to be answered. In fact, there are more than 4,000 on the waiting list in Cork for gynecological appointments and it represents 42% of all the waiting lists for gynecological services in the country. One solution with which the obstetricians and gynaecologists in Cork came forward was that they would be allowed to rent space in another facility to remain in charge of the patients either under their care or waiting to see them to avoid the problem which sometimes arises with the NTPF where patients avail of the fund and then come back into the HSE system which picks up the pieces. It is important there would be continuity of care, and the proposals from the obstetricians and gynaecologists in Cork should be taken on board.

One of the problems in the health system is that there are 2.8 beds per 1,000 of population. Irrespective of whether one wishes to undertake a day case procedure or an inpatient procedure, there are three core issues. A consultant is needed, theatre space is needed and a bed is needed. If one of those is missing, the procedure cannot go ahead. The most immediate way of dealing with some of the lists is to open up day case facilities because many procedures which previously necessitated an inpatient procedure are now day case procedures. For instance, I was in Cork on Monday where the Taoiseach was opening a day case facility for paediatrics. That is an important development. Medicine has moved on quite a lot. However, it does not sort out the problem. If we do not have the day case beds, we still cannot do the procedures. We need to look at how can we fast-track any proposals on day case procedures.

I raised the Cork situation and the Minister met the consultants in Cork University Hospital. That is something that needs to be fast-tracked to come to a solution and deal with it. There are 17 consultants or 12.5 whole-time equivalents. On the problem about theatres, one theatre is open 3.5 days a week and the other theatre is not open at all. It is about access to staff. I note the Fianna Fáil amendment refers to opening up beds. We can only open up beds if we have staff. That is our big problem as well. We need to be able to recruit the staff. The Minister has given a commitment to recruit an extra 1,000 nurses this year and I welcome that. However, in all the units throughout the country, to open up the beds, staff are needed to manage them.

I have a problem with our health service. We have followed the health system of the UK over the past 40 or 50 years and we now need to look at alternative systems. In the way we structure the employment of doctors, nurses, care assistances, I am not convinced it is the best system. It is something we need to review urgently. I hope the ten-year strategy would look carefully at that.

I refer to the Cork situation to highlight this issue. The Minister was not present in the House when I stated that the population of Cork has increased from 410,000 to 542,000 in the past 30 years and there has been no increase in the number of hospital beds in that period. There has been an increase in population of 130,000 and it is something that needs to be prioritised.

The Fitzgerald report of 1968 referred to a second major facility in Cork. It referred to two new hospitals. One was built and we forgot about the second. Now with the increase in the population and the talk of Dublin not being able to deal with it, we need not only to consider other areas of the country, but also to have backup support in other areas, whether in education, medical facilities or many other areas. Regarding access to hospital facilities, one of the areas we need to consider urgently is the southern region. As recently as this morning I received from someone in Brussels a text message stating that anyone seeking to have the European Medicines Agency relocated in Ireland should come to Cork. One must make sure all the necessary infrastructure is in place. People considering the relocation are watching these important issues.

Sinn Féin has referred to the issue of computerisation, of which I am a very strong advocate. Over the past 25 years, we have put too little money into capital expenditure on our health service. I am convinced we are 20 years behind in computerisation. We have 1,700 different computer systems in our health care system. Denmark's system has 25 and is working towards reducing this to five. It has saved a huge amount of money because of this computerisation. In fairness, this ties in with the point raised by Sinn Féin that computerisation results in far more accurate figures.

I wish to raise one final matter. More than 3.2 million people had outpatient appointments in 2015, of whom 487,000 people did not attend. This is over a 12-month period. My colleague raised Galway in this regard. In 2015, 35,000 did not attend their appointments in Galway. This raises the questions why and how this arose. It may not have anything to do with the patient but it is a huge issue in that the non-attendances are a waste of the valuable time of nurses and doctors.

The Senator is over time and the Minister wants time to reply.

We need to consider the matter. Again, I thank the Minister for being here and my colleagues for bringing forward this matter.

I move amendment No. 1:

To delete all words after “That Seanad Éireann” and substitute:


- 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; and

further noting that:

- the monthly waiting list data published by the National Treatment Purchase Fund does not provide a full, true and accurate account of the number of patients needing scheduled treatment;

- that HealthLinks data could be used to give accurate data on those awaiting out-patient appointments nationally; and

- that such an incomplete account of the waiting lists diminishes the credibility and accountability of our public health services; and


- the deplorable and dangerous overcrowding also being experienced in hospital emergency departments;

- the record number of patients waiting on trolleys, particularly the frail elderly;

- 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;

calls on the Government and the HSE to:

- hold accountable each hospital chief executive 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 out-patient waiting lists, access to diagnostic waiting lists and elective surgery lists;

- ensure each hospital group presents monthly updates on waiting list progress of each hospital in its region making transparent the difference between those patients awaiting a clinical procedure or elective surgery or an appointment to be seen in an out-patient clinic;

- ensure each hospital review the scheduling and utilisation of out-patient clinic space;

- ensure that each clinical director meet with each and every consultant providing out-patient clinics and elective treatment to examine the scheduling of clinics and procedure lists to match scheduling to demand;

- schedule elective diagnostic investigations 7 days a week;

- schedule elective surgery 7 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 out-patient 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 to publish all other waiting list data on a monthly basis as per the criteria used in the waiting lists currently published;

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

- commit to upgrades of the Community Hospitals network to help alleviate pressure in General hospitals.”

Fianna Fáil shares the distress and anger so many people feel over the long times patients are waiting on lists. The waiting lists and waiting times have been on a steady upward trend for the past three years. New figures show that there are now more than 632,000 patients on all waiting lists. Fianna Fáil has long believed that we should reactivate the National Treatment Purchase Fund to purchase spare capacity from the private sector in order to reduce the number of public patients waiting for treatment in public hospitals. We secured agreement for this in the confidence and supply arrangement and will monitor its delivery. Fianna Fáil also believes that in the interests of transparency and public accountability, all waiting lists compiled by the NTPF should be published so that we have the most complete picture possible. Regarding the point 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", Dr. Emily O'Conor, head of the Irish Association for Emergency Medicine, agreed with this sentiment when she appeared before the health committee recently.

I reassure all Members of the House that as a Senator, local general practitioner and medical director of Belmullet Hospital, I will continue to work tirelessly for the benefit of the patients and staff of that hospital.

I second the amendment.

I thank the Acting Chairman for the opportunity to address the Seanad on the issue of long waiting times for patients. I know Senators will contribute in the course of the debate and I thank them genuinely for maintaining a focus on this vital issue for our health service. I also acknowledge on the record of the House the constructive approach taken both in Sinn Féin's original motion before the House and in the Fianna Fáil amendment. Regardless of voting patterns in the House or however the House decides it wishes to deal with the motion, I wish to progress the matter and work with both parties on a number of issues referred to in their proposals. I also acknowledge, as did Senator Conway-Walsh, the brilliant facility we now have in Altnagelvin. It is a real, concrete, tangible example of what cross-Border co-operation looks like, and I was delighted to be there with the Minister of Health in the Stormont Executive, Ms O'Neill, last Monday. We have provided €19 million towards the cost of delivering the service in Altnagelvin, which will make a huge difference for the people of the north west in terms of access to radiotherapy services.

It is fair to say that, while this is a political Chamber, we are more united than divided on the way forward. Therefore, I, on behalf of Government, do not intend to oppose the motions before the House. Many of the suggestions made by both parties are in line with Government policy and work is already planned or in train to implement them. I have been clear that I believe improving our health service requires an all-party effort and I believe Senators are demonstrating they are of the same mind. I have previously said publicly and on the floor of Dáil Éireann that there is merit in the Sinn Féin suggestion and that I will meet Deputy Louise O'Reilly on the matter. However, before we introduce any new systems or structural change, we will have an all-party committee report in April, which is about each party outlining the system it wants. It was in this context, not in the context of a fobbing off, as Senator Devine suggested, that I made my comments to Deputy O'Reilly.

My feelings on RTE's "Living on the List" programme are well known at this stage. I can only add that the traumatic experiences of those patients left waiting in pain and anxiety and the shattering impact on those who love and care for them have only strengthened my determination that we must put first those who are waiting longest and reduce further long waiting times in 2017. I am unapologetic in my view that as well as this being a funding issue, there is an issue of management and accountability. Senator Mulherin has raised on a number of occasions the issues of management, roles, responsibilities, the purpose of those roles and how they are impacting or not impacting on various roles in front-line patient care. I have asked for a report on these issues and will revert to Senator Mulherin in this regard.

The Sinn Féin motion calls on me to explore the feasibility of a new model to maximise capacity of the public hospital system by means of the following core elements: the introduction of a new and single integrated hospital waiting list management system; providing a core activity budget to public hospitals; the introduction of a new activity fund; and addressing the public-private mix in public hospitals.

I will first address Sinn Féin's proposal on core activity budgets. I assure the House that the Government fully supports the concept of activity budgets. A Programme for a Partnership Government, published in 2016, confirms this Government's continued commitment to the implementation of activity based funding, ABF. Implementation of such budgets has already commenced through the HSE's ABF programme. Since January of 2016, funding for inpatient and day-case activity in the 38 largest public hospitals has been on an ABF basis. Hospitals are now given fixed ABF allocations, funding is being earned back following delivery of agreed ABF activity targets and performance is being monitored on a monthly basis. The introduction of ABF will deliver a number of key benefits. It is intended to ensure a fairer system of resource allocation to drive efficiency and increase transparency in the provision of hospital services in terms of the cost and volume of activity. The provision of funding for inpatient and day-case services will continue to be on an ABF basis during 2017. My Department intends to work with the HSE to ensure that the model is expanded to encompass outpatient activity.

I have repeatedly made clear that increasing capacity in the public health service is a priority. That includes physical capacity, the staffing capacity to support that and harnessing untapped capacity already in the system. Ireland’s improving economic position has enabled the health service to achieve much-needed budget increases in each of the last two years. Additional funding provided during 2016 presented the opportunity to address some immediate issues facing patients, such as investment in a winter initiative. Under the current winter initiative, funding has been provided to open approximately 100 extra acute beds this year. Ninety of these are already open. During the past year, over 100 additional hospital consultants, almost 250 extra non-consultant hospital doctors and nearly 500 additional nurses and midwives have been employed by the HSE. In addition, my officials are working with the HSE to develop a national integrated strategic framework for health workforce planning, with the objective of recruiting and retaining the right mix of staff. I expect to receive a report and an implementation plan during 2017.

The motion also refers to a suggestion from Sinn Féin to establish a new fund to cover the cost of procedures for those patients transferring to a different public or participating private hospital. Budget 2017 includes an allocation of an additional €15 million to the National Treatment Purchase Fund, NTPF, to enable patients to receive treatment in other hospitals. These can also be public hospitals. In implementing this, the HSE and the NTPF will work together to maximise capacity in both the public and the private sector. Under this arrangement, lower-complexity day-case procedures will be outsourced to the private hospital sector in order to free-up and maximise capacity in the public hospital system to undertake more complex inpatient treatments.

Sinn Féin's motion makes reference to an end to the special treatment of private patients in public hospitals. The Committee on the Future of Healthcare is examining different funding models for the health service and will make recommendations, according to its terms of reference, on the funding models that are best suited to Ireland, having regard to the aim, to which all parties have signed up, of moving towards a single-tier health service. It has been the policy of many successive Governments to allow public hospitals to continue to cater for the needs of private patients, based on the benefits accruing to those hospitals from having a balanced mix of public and private practice. This is also reflected in the current contractual arrangements with many hospital consultants.

The last point of the Sinn Féin motion, which is the one most directly linked with the management of waiting lists - I believe it is the most important point - makes specific reference to the Portuguese integrated hospital waiting list management system. There is no doubt that IT can play a significant role in underpinning a more integrated approach to managing waiting lists which would achieve a more patient centred approach, while optimising resources. Last summer, I asked the HSE’s office of the chief information officer to respond to a digital challenge to propose technological solutions to reduce waiting lists. As part of this e-health digital challenge, the Portuguese waiting list IT system was reviewed. In essence, I would agree that greater integration of hospital waiting list management systems would be a step in the right direction. I, therefore, accept the proposal in the Sinn Féin motion to examine the feasibility of progressing to a more integrated approach to waiting list management at hospital group level and I commit to request the NTPF to lead a project team to report to me within six months on the issues to which the Sinn Féin motion gives rise in this regard.

One of the critical enablers of any integrated waiting list management system is the unique individual health identifier, IHI, which was given a legislative basis in the Health Identifiers Act 2014. The system of identifiers will be deployed across the public and private health care systems. The electronic health record became reality in December 2016 with the arrival of Ireland’s first digital babies in Cork. New babies born from December in Cork University Maternity Hospital will now all have electronic health records with the deployment of the IHI register in the health sector.

I will now turn to the Fianna Fáil amendment. I want to address the issue of the maintenance and publication by the NTPF of national waiting list data. The NTPF figure provides an up-to-date and verified picture of patients actively waiting for inpatient day case treatment and outpatient appointments. These official waiting lists are published online on a monthly basis. The NTPF receives over 2 million records per month from hospitals and distributes up to 2,000 reports per month. The NTPF does not currently collate hospital diagnostics waiting lists but work is ongoing in the NTPF on testing the feasibility of compiling such waiting lists. I accept the premise of the amendment in this regard. In 2014, the NTPF guidance to hospitals regarding waiting list management advised that hospitals needed to keep a record of patients pre-admission and awaiting planned procedures and the NTPF has been capturing these data since then. Last Thursday, I committed to asking the NTPF to work towards the publication of the pre-admit and planned procedures waiting lists. The NTPF will review and advise on clinically appropriate time bands for these two different categories of patients. Let me be very clear, in case there is any political charge, the published figures have not changed under my tenure, or any other tenure. In fact, it is the same data set published each and every month since the NTPF was set up by Deputy Micheál Martin in 2002. That is not a political point; he was following best international practice at that time. The idea that there was some change to massage or to hide figures is a charge that is simply not true. Last week, I also announced that the NTPF will audit the practices in each of the hospitals highlighted by the individual cases featured in the RTE documentary.

Finally on this issue, I note the reference by Fianna Fail to the national Healthlink project. I am confident that additional integration could be explored between the NTPF waiting list data and this referral infrastructure to enable GPs - as Senator Swanick will know also - to make informed referral choices. I welcome the references to accountability in the Fianna Fail amendment. This is an absolute priority for me. The HSE's performance and accountability framework, which has been revised and enhanced for 2017, sets out how the HSE including the national divisions, the hospital groups and individual managers will be held to account for their performance. It makes explicit the responsibilities of health service managers in the four domains of performance which are: access to services; the quality and safety of those services; doing this within the financial resources available; and by effectively harnessing the efforts of the workforce. My Department oversees and monitors the HSE's implementation of its performance accountability framework and monitors implementation of the HSE corporate plan and annual national service plans. I and my Department continue to meet with senior officials from the HSE on a weekly basis to monitor performance including in relation to waiting lists. Let us be very clear that if anyone in this House, or anybody in the State, believes that funding alone - although funding is important - will address the issues in our health service then it is a misplaced and misinformed notion. If it were that simple, then we would have had the best health service in the world during the Celtic tiger era in Ireland. We must get the resourcing piece right - and there was a need to increase health budgets and to do a lot more on the capital side - but we must also ensure that the thousands of managers in the health service are held to account for what they have signed up to deliver. We have many excellent managers. This is not a heads-must-roll mantra from a Minister. There are many excellent managers, but we must identify good practice, demand more of it, and where there is not good practice we must demand that improvement plans are put in place in the interests of patients.

Reference was made to the bed capacity review that is under way. This review will be comprehensive and will have a much wider scope than previous reviews, which focused on bed capacity in acute hospitals only. While acute hospital bed capacity is a critical component of the health service, it cannot be considered in isolation. It is directly affected by capacity availability in other parts of the health service, such as primary care, long-term residential care, home care, respite, rehabilitation and palliative care. Even within the acute setting, we must also take account of emergency and outpatient capacity and utilisation. In examining future capacity requirements, the review will assess current capacity in the health system and benchmark with international comparators. The review will assess trends in better utilisation of existing capacity, examining a variety of efficiency and effectiveness measures, and scope for further gains, all with a view to better planning of capacity. The review will look at drivers of future demand for health care, which is crucial, including demographic and epidemiological trends. The review will also assess how reforms to the model of care will impact on future capacity requirements across the system.

The Fianna Fáil proposal on better utilisation of hospitals without 24-7 emergency departments for the purposes of elective surgery is also in line with the plans currently being implemented. It is appropriate and important. We need to use every bit of capacity within the health service. Through the group structure, 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.

During 2017, each hospital group will develop a strategic plan that will show how each group intends to utilise all hospitals, including smaller hospitals, within the group.

Similarly, community hospitals are an essential part of our national infrastructure of public nursing homes and provide a mixture of long-stay and short-stay care. The short-stay beds include step-up step-down care as well as intermediate, rehabilitation and respite care. These are used in a flexible manner to meet local needs at any given time. Community hospitals and their services have been used quite efficiently throughout this winter period and this must continue.

There are some proposals in the Fianna Fáil amendment which cause difficulty although I recognise the thrust and the bona fides behind them. Greater availability and capacity in the public service is something we all want.

The public service agreement provides for planned services to be delivered over an extended day, running from 8 a.m. to 8 p.m. Monday to Friday or a five over seven day basis, while also providing emergency services. The agreement includes flexibility in rostering to facilitate this. To expand services, as outlined in the motion, numerous other issues would need to be factored in and it is important I say as much on the record. These include structural capacity issues, staff shortages across certain grades, contractual issues, possibly, and significant cost implications. However, the thrust of the proposals in terms of expanding capacity is something to which I can agree.

I wish to put on record that we must use 2017 to reduce the length of time people are waiting. I want specifically to discuss scoliosis. It concerns us all and the problem was put into particularly sharp relief by the brave children and young people who told their stories to "RTE Investigates".

Additional funding has been provided in recent years to develop paediatric orthopaedic services, including scoliosis services. I made €2 million available to the HSE in 2016 which saw 50 additional children and teenagers treated for scoliosis procedures under the initiative. While this investment made some progress, it is clear there is far more to be done. Last week, I met the chief executive of the children's hospital group and the chief executive of Our Lady's Children's Hospital, Crumlin. I can now confirm that the new theatre will provide the additional capacity for scoliosis procedures from April, following the recruitment of additional nurses. Furthermore, an orthopaedic surgeon post in the hospital in Crumlin will be filled by June. This means that from July the hospital expects to have additional capacity. The HSE will also submit to me a specific action plan on scoliosis by the end of the month. If this Oireachtas does nothing else, we have to get this issue sorted. Children have been waiting in agonising pain for scoliosis procedures. This is a priority for the year.

I expect to receive the HSE and National Treatment Purchase Fund, NTPF, waiting list action plans by the end of this month. In addition, I expect to receive a specific action plan on scoliosis. I look forward to working with Senators in progressing many of the constructive ideas in the Sinn Féin motion, the Fianna Fáil amendment and the many ideas brought forward to me by Senators on all sides of the House.

I understand the Minister is withdrawing at this stage and that the Minister of State, Deputy Byrne, will step in. I thank the Minister for his attendance.

I welcome the Minister of State to the House. I thank Sinn Féin for using the party's time to highlight this important issue. The kernel of the Sinn Féin case is clearly set out in the motion. A total of 632,000 patients were on published and unpublished hospitals waiting lists at the end of January 2017. Under the current waiting list system, waiting lists for outpatient appointments, diagnostic tests and day case and inpatient procedures vary drastically. Sinn Féin has set out all of this so I do not intend to repeat the substance of the motion.

I am sorry the Minister did not wait in the House a little longer although I know he has other pressing issues. We have to get down to some basics. RTE broadcast a programme called "RTE Investigates: Living On The List". We saw the Minister on television. He was not in the studio. By arrangement he had a private off-site interview with RTE. He talked about being ashamed and heartbroken. We were all ashamed and heartbroken. I am interested in hearing the progress of every individual who was on the list waiting for treatment as a result of that programme. Words are no good if we are not going to get something done. The RTE programme brought home the genuine pain and suffering of patients who have been waiting for far too long for treatment.

We heard what the Minister had to say. I understand the Minister has directed the National Treatment Purchase Fund to audit its practices in hospitals. We need to look at the National Treatment Purchase Fund. I want to declare an interest at this point. I served as a director of the National Treatment Purchase Fund. I know very well the workings of the National Treatment Purchase Fund. I am no longer involved but I was there in the beginning. The role of the fund has changed substantially, from an independent organisation doing a good deal of work to one that changed substantially under the regime of Senator Reilly when he was Minister for Health. When Senator James Reilly came into that office, he decided to scale it down. He brought it in and called it the special delivery unit. It was under his direct auspices in the Department.

The kernel of the trouble with the National Treatment Purchase Fund – I do not suggest there is any trouble with those in the fund – is the relationship between the fund, the HSE, which seems to be at the kernel of most problems in the health service, and the Minister. The sooner the National Treatment Purchase Fund can validate its records independently and without any interference from anyone, the better. That would be a good day's work.

We need to be clear on something. Why were there a number of lists? It is important that lessons are learned from that programme. RTE did us a service. However, it is terrible that families have to go on live television and pour out their suffering as a result of the waiting lists. The relationship between the HSE, the National Treatment Purchase Fund and the Minister needs to be cleared up. Ultimately, it is about treating those waiting the longest better as well as speeding up the waiting times.

I have no hang-ups or ideology about private versus public sector. The people who were on that programme are not especially interested in whether it is private health care, private hospitals or public hospitals. They want the best medical procedures for them at this time in the course of their health issues. That is important. If we have to source beds from the private sector, then let us source beds in the short term. Of course we would love a full public system that could cope with all the demands and waiting lists for people. Clearly, we have a problem there. We need extra capacity. Why do we have a situation whereby capacity beds are shut in public hospitals? People talk about capacity. We need more nurses and bed capacity. It has to be done. We cannot keep cutting back bed capacity.

Ultimately, the public are sick of the system and the amount of money invested in public health. Successive Ministers from all groups and none have been unable to crack the kernel of the issue and the problems in the health sector.

It is important we embrace information technology. How can we manage these lists? How can we put systems in place to produce one clear list? Is it not possible, when a patient is put on a list, that the patient can have an individual tracking number? The idea is that to overcome data protection issues, confidentiality and so forth the patient could access this tracking number and see where he or she is placed. The patient could have reasonable confidence about moving in the right direction for an elective procedure or any other procedure. We have to get a system and embrace technology. The Government is going to have to fund the technology to enable this to be brought together in terms of the listing system.

I could go on but I do not intend to. We need to improve the situation of the National Treatment Purchase Fund and its relationship with the Minister. Perhaps the Joint Committee on Health should examine this. We need an organisation that is completely stand-alone and separate from the Minister for Health and the HSE.

I welcome the Minister of State. This issue is back in focus again arising from the RTE programme and the shocking revelations of children with scoliosis having to wait in an inhumane way. If I say nothing else, I will say that someone needs to be held accountable. How can it happen that children who are in pain and who need surgery in a timely way are not being facilitated? In many ways it is understandable, given that much work is done following whatever topic the media has attention or focus on at a given time.

If there is a focus on trolleys, that is where the resources go. We seem to go from crisis to crisis. It is clear that there is a capacity issue. There has been an additional allocation to health this year. We have been told it is the largest allocation ever. I do not think we can get away from the issue of management accountability. This brings us back to the problem of the lengthy waiting lists being encountered by children with scoliosis who need operations. As I understand it, a person with private health insurance cannot avail of such surgery under the private health system because this service is provided through the public health system only. This means there are no options for these children and their families. While I welcome the Minister's approach to tackling this problem, which is something we all need to work towards, it is a disgrace that it has been going on for so long without being flagged as a priority.

On the capacity side, it is clear that we need more beds and more front-line staff. The issue of management arises again in this context. I suggest that in light of the current level of availability or capacity with regard to resources like theatres and beds, we need to move from a five-day health service to a seven-day service. I question the extent to which co-operation is being received from clinicians and consultants. I am speaking generally when I say that because I know there are some very good clinicians and consultants. As we are aware, clinicians provide private health care in public hospitals. It is well cited and known that there are delays in clinicians signing off to allow the HSE to get paid for the use of its facilities for their private work. I understand there are many delays with many clinicians and consultants in doing this. Obviously, this causes funding difficulties in the public health service. In many cases, clinicians are not available on call at weekends to come in to discharge people. It has to be said that when people come to meet consultants, they often meet a registrar rather than a consultant because the consultant is somewhere else. These are serious issues. It is obvious that we have a deficit in consultants. Everybody across the board has to play ball or else it is just lip service. Given that many people with serious conditions and health problems need health care, consultants cannot just say "we are entitled to a lot more money somewhere else". It does not wash. I think there has to be a conversation about the sort of service they provide.

I would like to ask a couple of questions about HSE management and the recruitment of administrative staff, particularly grade 8 staff and general managers. I have flagged these matters previously. I raised them in this House on 25 January last in the presence of the Minister of State, Deputy Corcoran Kennedy. I have also raised them with the Minister at the Fine Gael Parliamentary Party, but I have received no answers. How many grade 8 officials and general managers have been appointed at Dr. Steevens' Hospital and throughout the country over the past three years? How many of them are involved in managing staff who deal with direct patient care? My understanding is that there are all sorts of new managers under the new business model. There are new types of managers in areas like business relationships, corporate business and business intelligence. I really do not understand what it means. It seems crazy that people can be recruited to manage statistics and targets when there are no people on the ground to deliver those targets and statistics.

I have called for a review of how the seven health care groups are operating. I understand the director general recently signed off on three project officers per health care group. My understanding is that these will be grade 8 positions, at a minimum. What are the people in HSE management managing? Have they not lost the run of themselves? Where is the money for these positions coming from? Business relationship managers have been appointed to resolve disputes between operations, business and targets. I do not understand it and I think it should be explained. Even though I do not understand it, I would like to know how it can be justified in the absence of sufficient staff on the ground. How can it be justified when many people cannot get home help or home care packages and there has been a reduction in the number of physios? The inability to recruit is a problem for HSE management. How many high-grade assistants have been appointed to assist the national directors at Dr. Steevens' Hospital? There is something wrong. I asked these questions formally on 25 January last, but I have not received any answers. I know the Minister has not received any answers, which is wrong. I ask the Minister of State, Deputy Catherine Byrne, to ensure these questions are answered so that the facts can be put on the table about how the system is operating because it is not on.

I am practically concluded. We are trying to take on the status quo within the HSE, which seems to preserve itself at the higher level. It has to be accountable for how the health service is being delivered. It must explain how children with scoliosis, for example, can end up waiting so long without such delays being declared an emergency or a matter of urgency. People have to be held accountable. I find it ridiculous that managers cannot be sacked. It would not happen in any private job. It seems that the only people responsible for health who are sacked or moved along are Ministers. As far as I am concerned, it is always the politicians who are accountable. The well-paid managers in the HSE, who are paid much more than most politicians, should be held accountable.

People in Ireland are living and even dying on waiting lists. It is right that this is of concern to everyone. The nation was shocked by the stories that were revealed on "RTE Investigates: Living on the List" on Monday, 6 February, which was not much more than a week ago. The harrowing stories we heard on that programme have served to connect us in a powerful way with the people behind the numbers. It is said that a week is long time in politics. We are living with this truth with everything that is going on at the moment. I thank the Senators who have proposed this motion to ensure the life-and-death matter of people on waiting lists continues to capture our sympathy and, more important, our attention. We must resolve to address it.

If the waiting list numbers are accurate and can be believed - an issue that is directly addressed by this important motion - the most recent indication is that there are 632,000 children, men and women on waiting lists in Ireland. I wish to focus on the facts as they pertain to women who are on the waiting list for life-and-death gynaecology assessments, treatments and procedures in Cork University Maternity Hospital. Ms Patricia Connolly is a 37 year old woman whose life has been blighted by pain. She waived her privacy and anonymity to share her story on "RTE Investigates: Living on the List". She is on painkillers as she waits and waits on the list. According to the National Treatment Purchase Fund's figures for gynaecology waiting lists at Cork University Maternity Hospital, some 4,350 women were waiting for outpatient assessments at the hospital in January of this year. There had been a reduction in the figure when 100 patients were outsourced to the Mater Private Hospital. There are 459 women on the inpatient waiting list for Cork, of whom 412 are on the waiting list for Cork University Maternity Hospital and 47 are on the list for South Infirmary Victoria University Hospital. The figure of 459 was arrived at after 50 patients were removed from the list through outsourcing. Although the National Treatment Purchase Fund helps a small number of people, it is not a long-term solution. We need long-term capacity so that people are not in desperation and despair as these lists build up.

In The Irish Times yesterday a respected GP in Cork was reported as stating that very probably women had died as a result of having to wait for a gynaecological check in Cork University Maternity Hospital. Dr. Mary Favier said:

Of course, the difficulty is that you can't say for certain that somebody has gynae cancer - there are some symptoms that are suggestive of it, so if somebody bleeds after the menopause they get seen quite quickly ... because there is a high risk of gynae cancer.

But it's the in-between ones who may have gynae cancer but are not showing any signs and need investigation; they are the ones at risk. So I would say, yes, definitely, without a doubt there are people dying on the gynae waiting list because of the delay.

I organised a briefing for Members of the Oireachtas on 9 January with the doctors at CUMH, long before the "Prime Time" programme was broadcast. At that meeting a Deputy asked why there had been no outcry about the number of women on the waiting list for gynaecological treatments in Cork, given the scale of the problem. One answer was those on the waiting list were women. Women keep quiet and do not talk about conditions such as the menopause, period pain, heavy bleeding or prolapse. It is not a subject to be discussed in mixed company. Women often keep their concerns to themselves so as not to upset or worry their children and families or to jeopardise their jobs. I had problems with bleeding and was barely able to go to work; therefore, I know and knew this from direct experience. Women battle on knowing that something with their gynaecological health is very wrong or even fatal.

The doctors have not been silent. They have been raising awareness internally of the alarming growth in gynaecology waiting lists for years, but their worries and concerns have consistently been minimised and ignored. This has resulted in CUMH having the longest gynaecology waiting lists in the country. The doctors eventually felt they had to go public and be political. It is not a doctor's job to talk to the media or politicians, yet this is what the doctors felt they had to do to attract some attention to this issue. They outlined a practical four point plan. The first was that additional gynaecology theatre staff should be employed to increase the level of theatre capacity from 30% to 100%. We were shown around an empty theatre which had been built for the purpose of dealing with gynaecological procedures. They also suggested developing and staffing a gynaecology day unit, an issue raised by Senator Colm Burke. They recommended building and staffing the gynaecology one stop shop which was part of the gynaecology plan published by the HSE in 2014. They further suggested employing a minimum of four additional consultant gynaecologists. Each of these things has to happen together. Using the National Treatment Purchase Fund or cherrypicking one of them will not help to solve the problem.

The doctors eventually received some attention and put their four point plan directly to the Minister for Health, Deputy Simon Harris, on 12 January. The Minister agreed to meet them and management again in six weeks. In fact, he asked me to contact his office to set up the meeting. What I want to know is whether he has been active in engaging with local HSE management and doctors since 12 January? What progress can he report to the women of Cork city and region and Members of the Oireachtas who are rightly concerned about the out of line, out of kilter gynaecology waiting lists in Cork? I know that one has not been set, but I have been asked to contact the Minister's office to set a date for the meeting, which is encouraging. Will he commit to and guarantee that he will see to and fix the dysfunctionality and the communication and teamwork breakdowns between doctors and management in CUMH and provide the resources needed? If local HSE management was asked if it was effectively harnessing the efforts of the workforce - its own performance indictor - I do not know how it would be able to answer the question in all honesty, given the size and scale of the problem.

Can the Minister eliminate the gynaecology waiting lists at CUMH which are the longest in the country? The only acceptable answer to that question for the women of Cork is: "Yes, I can; yes I will and I will follow through with actions and resources." That is why I welcome and support the motion. I also welcome and support Fianna Fail's motion. They should be added together, rather than have one substitute for the other because there is merit in both. People on waiting lists around the county, in particular the women of Cork, must receive the attention they need. It is a shocking shame that it has taken all of this effort and energy to shine a light on the problem.

I commend Senator Colette Kelleher for sharing her personal testimony with us. It is very brave and courageous for a person to share his or her personal story with the House. It is very difficult and I congratulate the Senator on doing so. Since she entered the House she has been a very strong advocate for maternity, gynaecology and obstetric services at Cork Univeristy Maternity Hospital.

I commend our colleagues in Sinn Féin for introducing the motion which has been framed in a very sincere and genuine way in an effort to advise and support the Government in improving health services and the way they are managed. I would be interested to hear from the Minister of State, Deputy Catherine Byrne, and others about the cost of introducing such a system. There is significant capacity to adopt new technology to ensure better outcomes for patients and that the limited resources available will be applied in a much more sensible way. Senator Colm Burke is correct when he says there has been an issue in recent decades with capital investment in health services. One of the deficits is in the application of modern technology in the way the health service is organised. There is huge potential for digitisation and computerisation. I have some sympathy, as I said on a number of occasions in recent weeks, with the Minister for Health and his ministerial colleagues in dealing with the scandalous problem of waiting lists. I accept in good faith the Minister's bona fides and that he is as disturbed and moved as the rest of us on hearing of the tens of thousands who have been waiting far too long for basic treatments or diagnostic services and often very complex treatments that, in some cases, are life saving or, in every sense, offer life changing possibilities.

I note that Sinn Féin has acknowledged and recognised that, whether we like it, there is a private element in the way the hospital systems operate. Many of us in this House would prefer if that was not the case, but that is not how the health system has evolved organically since the foundation of the State, or, as some argue, before. We might not like it, but that is the way the system has evolved. In the short term and the absence of a radical restructuring of the health service, we have to look at how we can use capacity in the private system in dealing with public hospital waiting lists. We need to resource the National Treatment Purchase Fund to ensure those on public waiting lists will be treated. However, the over-reliance on the National Treatment Purchase Fund in addressing the waiting list problem is just a sticking plaster and in many ways lets the HSE off the hook, although it is not the panacea to all our ills. We should never lose sight of the fact that the Government and the HSE which is resourced by the taxpayer have the responsibility to fix the deficits in the health service. It is only through better management - a change of focus in how we allocate the resources we have available - and the recruitment and retention of key staff and key expertise in the health service that we will able to fix the problem. While it represents an opportunity to move people through diagnosis and treatment over a short period, National Treatment Purchase Fund is not the panacea.

I accept that the Minister for Health is constantly on the hunt for additional resources.

The former Minister for Health and my colleague, Senator James Reilly, knows what it is like to battle for the resources required for the health service. Every Minister for Health knows what it is like. I know that every Minister for Health has worked extremely hard to resource the health service in the way in which it should be resourced. We know that in cash terms the health service received the largest budget in 2017 that it has ever received to apply to the HSE and all that agency is responsible for.

I mentioned last week, when the Minister of State, Deputy Byrne, was here for our discussions on the national children's hospital, that I am concerned we will be unable to meet the growing needs of our population in terms of health treatments and our responsibilities to Irish citizens in terms of the public health service if we do not get a handle on some of the escalating costs in the health service. What do I mean by that? I mean in particular the projected cost of the national children's hospital and the approximate €350 million that appears to be owed to hospital consultants. All that is before we open negotiations with consultants and GPs on new contracts and before we seriously try to fix the nurses' dispute and the dispute with SIPTU members in ancillary health service support roles. I remain to be convinced that the resources will be available even with the anticipated levels of economic growth we expect to continue, given all those challenges the health service will have. Will the Minister, either now or in the very near future, reassure the House that we can cover these bills without it having serious implications for the management and operation of the health service and our ambition to see it improved?

I wish the Committee on the Future of Healthcare well in its work. Its creation is an important advance. I do not believe that any citizen in this Republic ever accepts that one single political party or a number of Members of this House or the other House have a silver bullet to fix the problems associated with the health service. I am glad to see genuine efforts being made to develop a consensus on what our health service should look like and how it should be managed. The difficultly will arise when hard decisions must be made on how the health service is resourced.

I welcome this debate. I listened from my office to what the Minister had to say and to the other contributions. As the Minister is on the record as saying, it is unacceptable that our citizens must wait such a long time to get treatment. There is a long waiting list in outpatients. It used to be referred to as the waiting list to get on the waiting list. For the first time the waiting list has been properly tabulated and people have been made aware of it. There is a waiting time and waiting list for people to get in for surgery. There was a policy, rightly, of treating people with cancer and urgent cases first and then everybody else in chronological order. That measure was not implemented in many cases.

I know, just as Senator Swanick knows because he deals with the following in his surgery every day, that patients who are treated electively in a planned way will always have a better outcome from that than they will if they are left on waiting lists for inpatient treatment and their condition develops into an emergency. That is a real concern for patients, citizens and parents.

I welcome the Minister's comments about children. Unlike adults, children grow and the window of opportunity to intervene is very limited. If a child does not get an intervention at the right time, the result can never be as good.

I wish to point out again that no part of the health service operates in isolation. While we focus today on waiting lists for inpatient treatment and we focused several weeks ago on the most acutely ill lying on trolleys in hospitals, to attack either problem in isolation will not work. We have to look at education and advise people to see their doctor or public health nurse. We must get away from the old culture of only going to the doctor when sick as opposed to going to the doctor to keep well. That is why we now have more screening and why we need a new GP contract which emphasises the policy of resourcing and rewarding GPs for doing such work. That is how we will prevent illnesses and intervene earlier, thus keeping many people out of hospital and away from an operating theatre.

Equally, we need to do more day hospital work. Much of that work is being done at the moment. As I said in the House before, there are great examples of day procedures such as gallbladder procedures, hernia repairs, plastic surgery and cataract procedures taking place in Nenagh, Ennis, Louth and many other places. The list is quite considerable. Endoscopy can be done outside of a major hospital. All these procedures can be done in day hospitals. Sadly, this work is lacking in Dublin. We do not have a day hospital system in Dublin. We badly need one in Swords and north County Dublin to service the large population between the Mater hospital, Beaumont Hospital, the hospital in Drogheda and Cavan General Hospital. Two of these hospitals have national specialties and regional specialties. Despite this, we continually have situations where day surgeries and other surgeries are cancelled due to an overflow in their accident and emergency departments. I ask the Minister to turn his mind to the pressing need for new day hospitals throughout the country, particularly in Dublin and especially in north County Dublin.

We must examine what happens when people leave hospitals. We must analyse the need for step-down facilities for a short stay while people recuperate, as alluded to, and for a longer stay where necessary.

Again, we have too many people in the system operating at the wrong level. We have consultants doing work GPs can do and we have GPs doing work nurses can do. A classic case, if we want to prove the point, is colonoscopy. Advanced nurse practitioners perform colonoscopies. Nurses have tremendous skills and are excellent at delivering care. Many patients find it much easier to speak to a nurse than a doctor. That is not gender-based because patients find it as difficult to talk to a female doctor as a male doctor. I do not know the reason but the fact is nurses are a wonderful resource. Nurses must be given a greater role in prescribing and running protocols in primary care as well as more work in hospitals and more freedom to allow them do work currently done by doctors in hospitals.

Senators have touched on the subject of recruiting nurses. It is very difficult to recruit non-consultant hospital doctors or junior doctors. They are leaving this country mainly because of the manner in which they have been treated by the system and sometimes by their superior or senior doctors. I have asked the following question numerous times. Why does it take 12 years for a qualified doctor to become a specialist in this country? It only takes six years to become a specialist in the United States of America and other jurisdictions.

The health service has a myriad of problems but, without question, they can be addressed. If we keep doing the same thing in the same way and expecting different results, then as Einstein said, it is the definition of insanity. We need to change things. Many changes have been made.

I want to correct the record. Senator Boyhan spoke about the National Treatment Purchase Fund, NTPF, and inferred that there had been some interference by the Minister. The NTPF was not discontinued and its board was not dismissed. The NTPF was asked to do a different job because we did not have the money to fund it and I will not score political points about why that was the case. The reality is we did not have the money. The small bit of money we did have we put into a special delivery unit, which is an entirely separate entity.

With that small amount of funding, the NTPF, with the co-operation of front-line staff, made a huge difference. The numbers on trolleys were reduced by one third and waiting times for inpatient treatment fell to eight months. This is not just about money, although money was a real problem then, particularly in 2013 and 2014. There is more money going into our health service and I welcome that but I do not want to see it going down a black hole. I echo what has been said here about management and accountability but I also want to remind people about the amount of money we spend on training and supporting doctors and nurses in terms of continuous professional development and so forth. What do we do for managers? Many are plucked from administration jobs, put into management and then left there without the supports to allow them to continue to learn and to do the job that we want them to do.

I will conclude by saying that I hope the additional money that has been allocated to the health service will have the required impact and lessen the suffering of our citizens. We do not want to see our loved ones, families, friends and members of our communities suffering when we know are spending so much money on health. The NTPF is welcome in terms of having additional funds but it is only a temporary sticking plaster. If we do not address the core of the problem, we will never fix it.

Tá mé chun mo chuid ama a roinnt leis an Seanadóir Gavan. Tógfaidh mé cúig nóiméad agus beidh trí nóiméad aige.

Cuirim fáilte roimh an Aire Stáit. Tá an-áthas orm tacaíocht a thabhairt don rún atá os comhair an tSeanaid anocht. Tá an-áthas orm freisin faoin gcur chuige atá ag an Rialtais maidir leis an rún seo. Is maith an rud é go bhfuil an Rialtas ag glacadh i bprionsabal leis an rún. I welcome the Minister of State and I welcome the approach that has been taken by the senior Minister in the Department of Health to this motion. I am glad that he has been so positive towards it because it was put forward in a very constructive manner.

The figures are very stark. Indeed, they are always stark but we have become somewhat immune to them. There were 425 people on trolleys today, 28 of whom are in University Hospital Galway, UHG, my local hospital. These are huge figures but we have become so used to rattling them off that we forget how many people are actually affected. I was in UHG recently and I saw the situation for myself at first hand. The conditions in places like the emergency department are absolutely unbearable. My heart really goes out to all of the clinicians and nurses. The work they are doing is incredible. The same is true of the paramedics who come in with the ambulances and look after people on trolleys.

We have particularly chronic issues in the west when it comes to waiting lists. In UHG we have the longest inpatient and outpatient lists in the country. The figures in UHG are double the nearest other worst-case scenario. We often have the highest number of patients on trolleys and we have a mental health system in the west, which I have raised previously with the Minister of State, that is in absolute chaos. The situation is particularly bad in that area. I have called on numerous occasions, as have other Members of this House, for the Minister to visit the hospital in Galway. He was supposed to visit recently and it is a shame that he did not get there. I hope that he will come soon. There have been calls from across the board for consideration to be given to providing a new hospital in Galway on either a greenfield site or on the Merlin Park site. I do not know which would be best but we must first conduct a feasibility study. Every time I have raised this issue with the Department, it has been shot down and I have been told that the Department will not even bother to look at it but it is the least we can do for the region. Galway is providing services for people from Donegal all the way down to Clare, a huge area, as part of the Saolta University Healthcare Group. The least we can do is some kind of feasibility study on the development of a new hospital in Galway which would take some of the pressure off UHG.

We had 12,454 cancelled surgeries in the west last year, across Galway, Mayo, Sligo and Roscommon. In UHG, the figure was 6,194, in Sligo General Hospital it was 1,958, in Portiuncula in Ballinasloe it was 976, while in Roscommon the figure was 815. These figures from the Saolta University Healthcare Group, which covers all of that region, demonstrate that there is an east-west divide when it comes to cancelled surgeries. The main reason for surgery cancellations is capacity constraint. In many cases, our acute hospitals are at 95% and 100% capacity and do not have any spare wriggle room to deal with crises.

There are 42,000 patients on inpatient and outpatient waiting lists in UHG. There are 31,000 on the outpatients list, 4,700 of whom have been waiting over a year. Areas of particular difficulty include orthopaedics, cardiology, dermatology and ear, nose and throat, ENT. The inpatient list at UHG is twice as long as the next worst waiting list in any other hospital and one quarter of the 11,000 people on that list have been waiting for over a year. I must say, having visited the hospital recently, that the front-line staff are absolutely excellent. However, there were a number of practices I noted that are of some concern. I saw people being brought into the emergency department on a Friday evening and being held over a full weekend until Monday because diagnostics or consultants were not available. People were kept for three nights in the hospital which may not have been necessary had tests been done over the weekend. I also noted something quite strange. I saw three security guards on a ward with a number of older people. I wondered if they were expecting a fight but after a while I realised that a number of the patients had either dementia or Alzheimer's disease and had a tendency to wander. Three private security guards were attached to individual patients. What is the cost of that? Would it be not be cheaper to have nurses available to look after such patients? How appropriate is it to have that work carried out by people who do not have training in the area?

I was contacted recently by several health care assistants, HCAs, who were brought in recently and promised that they would have contracts within 18 months. They are still waiting for those contracts but agency workers are being brought in at a much greater cost to the HSE.

The issues around addiction services in the west have not gone away. I have raised them with the Minister of State previously. People who have been looking for alcohol addiction services since before Christmas are being turned away because they have not gotten a dual diagnosis. It is a big problem because these people are ending up in the acute system, taking up beds.

I welcome the fact that the Government is willing to take on board this Sinn Féin motion. I call on Fianna Fáil to withdraw its amendment and, in the spirit of new politics, support what we have promoted.

I am not going to repeat what has already been said but I will make a couple of additional points. I welcome the very constructive contributions from Senators on all sides. This debate is a demonstration of this House working at its best, where rather than scoring points, my party is trying to come up with constructive proposals. I acknowledge that the Minister has recognised that by not opposing our proposals today.

I want to talk about Limerick, with which I am very familiar. There are 37,000 people on the waiting lists there at present. There are major issues in terms of the chaos in Limerick and the impact that has on both recruitment and retention of staff. A colleague of mine in the trade union movement described a situation of nurses in absolute turmoil and tears because they had lost a patient who was pushed onto a corridor and who, for that reason, did not get the help needed. It is those kinds of situations that lead nurses to make the decision not to stay here and to go to Australia or to Britain. To be fair, we are only going to be able to address the recruitment and retention of staff in the health service if we acknowledge the chaos that currently exists and the need to address that chaos immediately. We must also recognise that terms and conditions for key staff, namely, support staff and nurses, must be improved. In that respect, we must have an honest conversation about the fact that if we choose to cut capital acquisitions tax, inheritance tax or the universal social charge, USC, we will not have the funding for the additional 96 beds that are needed in Limerick right now. These are political choices and all of us have to do better than that. We have to recognise that if we are going to fix the problems in our health service then, as Senator Colm Burke rightly pointed out, additional capital investment is essential. We do not have enough resources to be able to give tax cuts and improve services and we have to make a fundamental choice in that respect.

There is a need for better regulation of nursing homes. I have seen some dreadful conditions in private nursing homes and with private home-help operators.

I reiterate what my colleague, Senator Ó Clochartaigh, said. Given the constructive nature of the debate today, I cannot see the point of Fianna Fáil Members trying to wipe out our motion today. I appeal to them to be constructive here and let us see the best of our Chamber by acknowledging the worth of our motion.

I do not want to begin on a discordant note. In the spirit of the motion and the amendment, the fundamental point is that if we are spending money in the health service we must have accountability in how that money is spent. It is not the case that we have a pot of gold, as Sinn Féin has discovered in the North of our country where it has had to make tough decisions in government relating to the health system.

I have huge respect for Deputy Ó Caoláin, with whom I worked in the previous Oireachtas Joint Committee on Health. However, other Sinn Féin Deputies seem to want to be populist and promise all things to all people. If we are to have a cross-party collaborative approach to health, let us have it in real time and real terms. We do not have enough money to spend on everything and we need to recognise that the most important thing we can do as a country is to have people at work who can make a contribution so that we can have money to pay for services while at the same time respecting that those who need our help and assistance should have that from the State.

We all begin from the premise that the waiting times are unacceptably long. The most important point is that this is about expediting access to surgery and treatment. Those of us who are living in the real world have people coming to us every day of the week looking for hospital appointments fast-tracked or to be taken off a trolley.

We need the whole of the Oireachtas to stand firm in bringing reform, including the HSE's lack of accountability because there is no person who will take the flak for the waiting times or for the cancellation of appointments. Senator Colm Burke has been beating this drum for a long time. While I accept there has been a multiplicity of reasons, 487,519 appointments have been cancelled. What does that do to the system? Trying to bring reform through the future ten-year strategy or whatever requires us to stand up to vested interests. I say to Senator Gavan that means standing up to the unions. I say to Senator Swanick that means standing up to the GPs and consultants. We all need to ask how we can make it better for the patient, who is at the centre of what we should be doing, as opposed to pursuing vested interests.

The amendment to the motion indicates what Fine Gael is trying to do in government. We must change work practices relating to diagnostics. It is crazy that a person cannot get an X-ray on a Sunday. I know of a patient who has been in hospital since the second week of January because his consultant is not available to carry out an operation and he cannot leave the hospital bed because if he does, the operation will be cancelled. That is the height of daftness; it makes no sense. I can get an operation in a private hospital at 9 p.m., but in some cases we cannot do that in public hospitals. Where we find commonality is in how we can change work practices, as Senator Reilly said.

I believe the model of the money following the patient is very good because it delivers to hospitals that perform and treat patients as patients, and get benefit from it. We need to revisit the special delivery unit model, because it delivered at a time when we did not have money in our health system. It went down to the coalface and had an impact. It engaged with clinicians and analysed what could be done, and delivered.

Irrespective of our ideology, we all agree that we need more beds, be they in Limerick, Cork, Galway or Mayo. Senator Colm Burke pointed out that the last new hospital built was in 1998. If we went into our communities and said that there was no new school built since 1998 we would be frogmarched to every public meeting and told it was unacceptable. I fully endorse what Senator Colm Burke has been saying, namely, we need new hospitals. This could be done through public private partnerships. We can approach the European Investment Bank proposing a model that can deliver patient care, cutting waiting lists and getting people inside hospitals. I accept that is a quantum leap for some.

I have made that journey because I have the experience of teaching in a public private partnership school. Let me tell Members who have a difficulty with that, the school is still there. There is no denigration of service. There is still community access. The building is pristine and the school is operational. Why can we not do the same with our hospitals? We do it with our roads and pay a toll. Today someone travelling from Cork to Dublin will pay a toll; we could use public private partnerships to deliver hospitals buildings.

The Senator should not point his finger.

I am not; I am making a point. The Senator should relax.

The Senator needs to relax.

Let us look at the model of delivery of our public hospitals. We can see what the private hospitals can do.

Senators Colm Burke and Kelleher spoke about the maternity services in Cork University Hospital. I welcome the appointment of John Higgins to his post. He has done a huge job in his role on reconfiguration. He is an eminent person who will deliver for Cork University Hospital and for the women and babies who require treatment and urgent access to diagnostic services.

Cork is the second city and the capital of the south. The region needs a new hospital. I will not have a debate in the House today on how or where we should build the hospital. However, we need an increase in the number of beds available in Cork. We need a new hospital. In tandem with that we need investment in the Mercy University Hospital and the South Infirmary-Victoria University Hospital, not least because those hospitals provide a service that is incrementally important to the different catchment areas and the specialties that are being catered for in those hospitals. On Monday Senator Colm Burke and I were in Cork University Hospital when the Taoiseach opened the first phase of the paediatric unit. Many people made a gargantuan effort in the fundraising for and delivery of that project.

I welcome the agreement on the broad thrust of this motion. I welcome the Pauline conversion of some to how we should do business in the health system. However, it requires a collegial common approach. It is regrettable that no Member of this House is a member of the Committee on the Future of Healthcare. Just to name the people here, Senators Devine, Kelleher, Colm Burke, Reilly and Swanick could provide valuable insight to that committee. They were deprived of that opportunity and should not have been. This motion will bring commonality. However, what will require further commonality is that we agree that there is no one model that will deliver. We need to put the patient at the centre of what we do and tackle the vested interests because if we succumb to vested interests we will not succeed in reforming our health system.

I also commend Sinn Féin and thank it for tabling this issue in Private Members' time. As we all know, the number of people on waiting lists for essential hospital procedures is a scandal. That has been spoken about a lot today. We also know that thousands of people are being forced to spend months in pain while they wait for an operation or to see a specialist. It saddens me deeply that we are one of the richest countries in the world and we cannot, or will not, take care of our most vulnerable, weak and sick.

The HSE states that even though the overall length of time people spend on waiting lists has improved in recent years, the total numbers waiting and the numbers waiting in excess of four months for outpatient assessment and inpatient treatment are at an unacceptable and unsustainable high. The HSE is working to ensure that no one is waiting more than 18 months for an outpatient or inpatient appointment. These figures give an idea of the problem but the personal statements of people in agony while waiting for operations are the most telling criticism of our health service. Families are forced to look at their loved ones suffering while the better-off in society, with private health care, can access services.

A friend of mine, whose wife is waiting for an operation, told me of the effect that it is having on him and how devastated he, his children and especially his wife are. She has become suicidal, not because she was depressed but because she could not bear the constant suffering and pain. Another friend of mine, and these are all people who are talking to me at the moment, wants to make a case for an opt-out clause to be introduced for organ donations. A Cork mother of two, Linda O'Mahoney, called for the Government to introduce the opt-out scheme which would mean that everyone would automatically be an organ donor unless they specify otherwise. The 40-year-old said she had to be at death’s door before she got a liver transplant and is calling for immediate action to try to tackle transplant waiting times. I ask the Minister if he would consider, or if he has a plan to introduce, this scheme.

The justified industrial action by nurses, midwives and hospital staff scheduled will have a major impact on waiting times. The grievances of these front line workers must be addressed as a matter of urgency. Senator Reilly mentioned the great work that our nurses do. The state of our health care system is summed up by the people who know best, the nurses, who do an incredible amount of work. We have heard comments from them like:

All my life I wanted to be a nurse. I love looking after people but I can’t do that as a nurse in Ireland. I didn’t realise that my dream would lead me to being a slave.

Another post that went viral and appeared in international media stated:

We are so unbelievably undervalued and we find it difficult to strike in numbers because people may actually die if we do strike as we are so short of staff. Who is going to look after the dying patients if we strike?

The president of the Irish Hospital Consultants Association, IHCA, Dr. Tom Ryan, said that the public had become immune to the acute crisis in the health care system, the thousands of extra hospital beds needed, the waiting lists of over a year and a serious shortage of nurses and doctors. These indictments of our health care system have to be taken seriously and acted upon. If nurses and other hospital staff are prepared to go on strike then we know the situation is critical. INMO industrial relations officer, Mary Rose Carroll, said that the conditions nurses are working in mean that they fear for their patients' safety.

On the comment that Senator Ó Clochartaigh made about addiction services, and I know the Minister of State is very aware of it, I will come back to the point that there are 1,500 people in hospitals every day who have an alcohol problem. We could easily lower that if we just looked at the issue of alcohol. That is what we are trying to do in the Public Health (Alcohol) Bill 2015. It really is an important issue.

Questions need to be asked as to why the number of senior managers in the HSE has grown by almost 40% in the past four years since 2012 while hospital wards are often understaffed due to the severe curbs on the recruitment of nurses and doctors. It is scandalous that we have an increase of 40% in senior managers in the HSE. There is something not right with that picture.

I call on Senator Rose Conway-Walsh. She has five minutes.

I will not even need five minutes. I just have a few words from earlier on. I want to thank Minister Harris very much for the spirit in which he is agreeing to take this very positive proposal on board and for putting a six-month time limit on investigating its feasibility, because I think it is a very positive suggestion. We have seen that it works in Portugal. The evidence is there. We do not have to re-invent the wheel. It does not cost a huge amount of money. The cost issue was raised earlier. I think it will cost something like €10 million initially. If we compare that with what was spent on the PPARS computer system, which I believe was something in the region of €50 million and which was a complete waste of money, it is a drop in the ocean. It would save us an awful lot of money.

I refer to what was said about the number of missed appointments. There are many reasons people miss appointments, but among my own constituents in Mayo the most common reason I find, particularly in respect of the Galway hospital, is that people do not have transport. Elderly people and others do not have transport and cannot afford to take the six-hour round trip to Galway by taxi for their appointments. They will not do so unless they really feel ill. If they can feel they can get away without having the appointment or putting it off to a further date, they will do that because they just do not have the money. At one time one could go to the community welfare officer and get some help with transport costs. I believe this is the single most prohibitive factor in people keeping hospital appointments at the moment.

This integrated list would help very much in scheduling. Somebody, for example, from Mayo, can have appointments three days in a row, in three different clinics in the Galway hospital or whichever hospital it is. If there was a properly integrated IT system, that person could have the three appointments on the one day rather than being seeing for ten minutes one day, taking the six hour round trip back and coming back again for a half an hour two days later. In that way, the list could be reduced and a lot of money could be saved. It would also take people out of pain who are currently suffering because they cannot get the treatment they need.

Deputy Harris referred to scoliosis, which I will address briefly because I know many scoliosis patients. I would ask him to look at the medical certificate that allows for transport, particularly for rural areas. If children or others have scoliosis and all that involves, they should automatically be entitled to a medical certificate that would give them and their parents some help with private transport, instead of being refused one time and time again.

That is all I will say. I appeal to Fianna Fáil at this stage to withdraw its amendment and to let this motion go through, for us all to work together in the interest of new politics and in the interests of the more than 600,000 people who are on the waiting list and for us to see if this would work and to give it a genuine chance of working. I appeal to Fianna Fáil.

I thank the Leas-Chathaoirleach, I thank the Minister of State for coming in and I particularly thank the Minister, Deputy Harris, for his genuine attempt to work with parties across the board to address this problem which has existed for decades.

Amendment put:
The Seanad divided: Tá, 28; Níl, 16.

  • Ardagh, Catherine.
  • Boyhan, Victor.
  • Burke, Colm.
  • Buttimer, Jerry.
  • Byrne, Maria.
  • Clifford-Lee, Lorraine.
  • Coffey, Paudie.
  • Daly, Mark.
  • Daly, Paul.
  • Davitt, Aidan.
  • Feighan, Frank.
  • Gallagher, Robbie.
  • Hopkins, Maura.
  • Horkan, Gerry.
  • Lawless, Billy.
  • Leyden, Terry.
  • Lombard, Tim.
  • McFadden, Gabrielle.
  • Mulherin, Michelle.
  • Murnane O'Connor, Jennifer.
  • Noone, Catherine.
  • O'Donnell, Kieran.
  • O'Donnell, Marie-Louise.
  • O'Mahony, John.
  • O'Reilly, Joe.
  • Reilly, James.
  • Richmond, Neale.
  • Swanick, Keith.


  • Black, Frances.
  • Conway-Walsh, Rose.
  • Devine, Máire.
  • Gavan, Paul.
  • Higgins, Alice-Mary.
  • Humphreys, Kevin.
  • Kelleher, Colette.
  • Mac Lochlainn, Pádraig.
  • Nash, Gerald.
  • Ó Céidigh, Pádraig.
  • Ó Clochartaigh, Trevor.
  • Ó Donnghaile, Niall.
  • Ó Ríordáin, Aodhán.
  • O'Sullivan, Grace.
  • Ruane, Lynn.
  • Warfield, Fintan.
Tellers: Tá, Senators Paul Daly and Keith Swanick; Níl, Senators Paul Gavan and Trevor Ó Clochartaigh.
Amendment declared carried.
Question put: "That the motion, as amended, by agreed to."
The Seanad divided: Tá, 34; Níl, 11.

  • Ardagh, Catherine.
  • Boyhan, Victor.
  • Burke, Colm.
  • Buttimer, Jerry.
  • Byrne, Maria.
  • Clifford-Lee, Lorraine.
  • Coffey, Paudie.
  • Conway, Martin.
  • Daly, Mark.
  • Daly, Paul.
  • Davitt, Aidan.
  • Feighan, Frank.
  • Gallagher, Robbie.
  • Higgins, Alice-Mary.
  • Hopkins, Maura.
  • Horkan, Gerry.
  • Kelleher, Colette.
  • Lawless, Billy.
  • Leyden, Terry.
  • Lombard, Tim.
  • McFadden, Gabrielle.
  • Mulherin, Michelle.
  • Murnane O'Connor, Jennifer.
  • Noone, Catherine.
  • O'Donnell, Kieran.
  • O'Donnell, Marie-Louise.
  • O'Mahony, John.
  • O'Reilly, Joe.
  • O'Sullivan, Grace.
  • Ó Céidigh, Pádraig.
  • Reilly, James.
  • Richmond, Neale.
  • Ruane, Lynn.
  • Swanick, Keith.


  • Black, Frances.
  • Conway-Walsh, Rose.
  • Devine, Máire.
  • Gavan, Paul.
  • Humphreys, Kevin.
  • Mac Lochlainn, Pádraig.
  • Nash, Gerald.
  • Ó Clochartaigh, Trevor.
  • Ó Donnghaile, Niall.
  • Ó Ríordáin, Aodhán.
  • Warfield, Fintan.
Tellers: Tá, Senators Paul Daly and Keith Swanick; Níl, Senators Paul Gavan and Trevor Ó Clochartaigh.
Question declared carried.