Hospital Waiting Lists

Dáil Éireann Debate, Wednesday - 25 June 2014

Wednesday, 25 June 2014

Questions (7)

Bernard Durkan

Question:

7. Deputy Bernard J. Durkan asked the Minister for Health the extent to which patients presenting for what are deemed to be non-emergency or non-urgent procedures are put on waiting lists for prolonged periods, often in very severe pain which results in great distress for them and their families; the effort being made to examine such cases with a view to ensuring the alleviation of pain becomes an issue in the determination of priority; and if he will make a statement on the matter. [27007/14]

Oral answers (6 contributions)

Deputy Bernard J. Durkan

This question relates to the number of incidents brought to my attention, whereby patients in need of particular procedures such as prostate operations, hip replacements and so on are being placed on waiting lists of considerable length. They are left, in the meantime, to suffer extreme pain which is highly distressing for themselves and their families.

Deputy James Reilly

Management of all patients on waiting lists takes place in line with an agreed national policy on waiting list management that issued in 2013. This policy was developed to ensure all administrative, managerial and clinical staff would follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. The policy describes the process for assigning priority to patients and all patients, with every person added to the waiting list assigned a priority category of either "routine" or "urgent". Several factors determine prioritisation of the clinical urgency of a patient and his or her subsequent scheduling, including pain levels. The decision on prioritisation is a clinical one, taken by a doctor, as is proper.

In addition to the national waiting list management policy, a toolkit to support the successful implementation of the new policy has been developed. The performance improvement toolkit for scheduled care focuses on the organisational, procedural and operational changes necessary to improve patient experience of scheduled care. It provides an organisational assessment tool to enable hospitals to understand their current capabilities and performance. It also identifies areas for hospitals to focus on improvements based on the organisational assessment.

With the assistance and support of the special delivery unit, SDU, and the National Treatment Purchase Fund, NTPF, 90% of adult patients were waiting less than eight months at the end of April, with 10% waiting for longer than the eight month target. That 10% comprises 4,462 patients, which compares favourably with the 5,302 adult patients who had been waiting for longer than eight months in April 2013. Even more significant improvements are evident in outpatient waiting lists, which indicate that 93% of outpatients had been seen within 52 weeks by the end of April, whereas only 73% of outpatients had been seen within 52 weeks in April 2013.

Should any patient consider that his or her clinical condition and-or pain levels are disimproving, it is recommended that he or she bring this to the attention of a GP who can bring it to the attention of the consultant, with a request that the level of priority of the patient be reconsidered.

Deputy Bernard J. Durkan

I thank the Minister for his comprehensive reply and acknowledge that considerable progress has been made on waiting lists in general. Moreover, I fully accept clinicians' right and duty to make the clinical decision in the first instance. However, my question relates to the pain suffered by persons waiting for treatment. When one tables a parliamentary question about such cases, the standard reply is that patients whose condition has deteriorated should contact their GP. However, if the patient had not been concerned in the first place, he or she would not have contacted a public representative. Would it be possible to review the status of those patients who seem to be on a circular list and whose only means of accessing treatment quickly is to go through hospital emergency departments, with the consequent disruption of that service? I am not satisfied that every case is treated with the urgency it should be given, given the severity of pain suffered by patients.

Deputy James Reilly

I can certainly consider the Deputy's suggestion on exploring how we might develop a separate route for patients who feel they are deteriorating, without requiring them to resort to attending an accident and emergency department. As a doctor, I am aware that if people are left to wait for a prolonged period, elective surgery can turn into emergency surgery. That is not something anybody would wish to see. It is only right and proper, however, that the clinicians make these decisions. It would not be proper for management to do so.

Major improvements have been made to waiting times but I acknowledge that they are still too long. We seek to continue to improve them through further reform of the health services and monitoring of waiting lists. Some hospitals have not been co-operating with the policy of seeing those who have waited longest first, once urgent and cancer cases have been dealt with. That is a problem.

Deputy Bernard J. Durkan

I thank the Minister for his reply. I hope he will be able to carry out a review of this issue. A case was recently brought to my attention involving an elderly lady who was awaiting a hip replacement. Although she was in extreme pain, her case was not deemed urgent or a priority. She had been waiting between one year and 18 months in that condition. In another case, a prostate patient was deemed as non-urgent. This unfortunate individual's family became extremely distressed at the extent to which he was in discomfort, screaming with pain on a daily basis. It was poor consolation to them when I forwarded them a reply suggesting that he should go to his GP. He would not have complained to me in the first instance if the situation had been the way it should have been.

Deputy James Reilly

If I may make a general point, nobody should be in pain. Adequate pain relief mechanisms are available and a GP would be in a position to provide such relief. I accept, however, it is not ideal that people would take painkillers for prolonged periods when a procedure could resolve the problem in a more comprehensive fashion. As we all know, some painkillers have side effects which can be serious in their own way. I take note of what the Deputy had to say. We are striving to improve the system. It has evolved in a chaotic fashion over many years and through various Governments, and we are trying to put order on it to benefit patients by ensuring that those who are waiting the longest are seen first and that people are seen in chronological order as they are referred rather than permitting people who have only been waiting three months to be seen prior to those who have been waiting six months, nine months or a year. That has been happening in our hospitals.