Dáil Éireann Debate, Tuesday - 18 October 2016
22. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he and his Department have precisely identified the most common causes for long waiting lists in respect of various elective procedures; when he expects these issues to be resolved with the objective of bringing waiting times to the minimum; and if he will make a statement on the matter. [30613/16]
View answerThis is the old chestnut of trying to identify the long waiting lists for various elective procedures, the causes of them, the most common delays experienced and whether it might be possible to put in place remedial measures to deal with them.
I thank the Deputy for raising this timely and important question. A key challenge for our health system is to ensure that patients have timely access to health services, in light of significantly increased demand. The overall demand for hospital treatment is increasing year on year in line with a growing and ageing population and the expanded range of treatments thankfully made possible by new technology. The Central Statistics Office, CSO, estimated an increase of almost 1% in the total population between April 2015 and April 2016, with the number of people in older age groups increasing at a faster rate. For example, the number of people over 85 years of age is currently increasing by 3.3% per annum. Thank God for that, but it puts extra pressure on our health service.
Every year there are over 3 million outpatient attendances at our hospitals and in the first half of 2016 there was an increase of over 4% in the number of outpatient attendances compared with the same period last year.
My Department works closely with the HSE and the National Treatment Purchase Fund, NTPF, to implement measures to try to improve waiting times. At my request in August, the HSE developed an action plan to reduce, by year end, the number of patients currently waiting 18 months or more for an inpatient-day case procedure. I expect it to deliver on that plan.
In addition, within current resources, the NTPF is currently implementing an endoscopy initiative which aims to ensure that by year end no patient will be waiting 12 months or more for an endoscopy procedure. We all know the importance of driving down that waiting time, and it has reduced in the last two months in a row.
Furthermore, €7 million of the winter initiative funding is to be utilised to fund a targeted waiting list programme - the Deputy is correct that targeting particular areas is important - to provide treatment for patients waiting for orthopaedic, spinal and scoliosis procedures.
Finally, budget 2017 provides for the treatment of our longest waiting patients. A sum of €20 million is being allocated to the NTPF. It is the first ring-fenced allocation to drive down waiting lists for a number of years. That will increase to €55 million in 2018. That is a total of €75 million for 2017 and 2018 specifically to use all the resources across the health service, public and private, to drive down waiting lists. Planning of this initiative is at an advanced stage by the NTPF, my Department and the HSE. I expect to receive proposals on this shortly, but the target will be those waiting the longest and areas of acuity where there is particular difficulty.
To what extent have individual and precise areas been examined with a view to identifying what might be done in the short term to alleviate some of the delay problems? For example, delays in waiting to see a consultant is a common cause put forward by patients. Subsequently, the next delay occurs when waiting for the procedure. What are the contributory factors in that regard? Is it due to a shortage of bed space, a shortage of theatre space, a shortage of theatre staff or a combination of all of them? To what extent can they be addressed and dealt with in the short term? These issues have arisen repeatedly for years. Bearing in mind the increase in population, the increasingly ageing population and the increased demand, is it not time to take an initiative that will have a telling, lasting and beneficial effect from the point of view of patients?
It is probably all of the above; it is a range of factors. It also comes after a very difficult period for the health service. Thankfully, we are now seeing re-investment in health again. However, there are some interesting points. We have a do-not-attend rate for hospital appointments of approximately 15%, which is much higher than it should be. I am not blaming the patients for this. Perhaps patients are waiting too long and by the time the operation can be carried out it is not needed or circumstances have changed. We must ensure we are reminding patients to turn up for their hospital appointments as well. People are given a scheduled appointment and they might forget to attend, but that costs the health service a great deal. It also wastes a large number of hospital appointments. We must drive that down. A do-not-attend rate of 15% works out at approximately 60,000 missed attendances at our hospitals every year.
That is an awful lot of hospital appointments and wasted time for doctors. In the circumstances, I plan to introduce a reminder system involving SMS messaging very shortly. That system will be important. We also need clinical verification. We need to ensure that people on waiting lists still need to be there and that they have not been referred to more than one doctor for procedures. We also need to see more procedures being performed in the community, which is the big win. We need to see GPs obtaining access to diagnostics. Many GPs tell me that it is a bugbear for them to be obliged to refer someone to an outpatient appointment to access a test they know they could provide themselves. I will revert with a suggestion I have in a moment.
I will not shock the Minister because I have asked him about this matter on a number of occasions. We have proposed an integrated system of waiting lists. It is a very good system. In fact, the Minister is on record as saying that it has some merits. I have contacted the Minister's office several times and he has said publicly that he would like to meet us to discuss the matter. I am happy to meet him for that purpose. I have contacted his office a few times but, as yet, no arrangement has been made. We need an integrated waiting list system that will address a large number of the issues referred to in Deputy Durkan's question. Could we have some time allocated to address that and could we know in advance how much of the budget the Minister has allocated to an integrated waiting list system or a similar system? It works in Portugal and could work very well here.
To what extent have we made comparisons with other jurisdictions that have similar population age profiles with a view to identifying what the obvious causes were? To what extent have any comparisons been made in respect of the primary care centres and their impact on the kind of thing to which the Minister has just referred? This relates to whether primary care centres are intercepting patients requiring procedures that can be performed at such centres, having particular regard to the very sophisticated nature, scale and size of the centres that are now being provided.
I am always happy to talk to Deputy Louise O'Reilly. While we have not had a specific meeting on this, we did have a good exchange at the Joint Committee on Health and I believe there is merit in her suggestion. However, there is a missing piece, although it is not the Deputy's fault. It concerns knowing what is on the waiting list. The fact that we do not have a unique health identifier means we do not know how many times a person could appear on a waiting list. The key to unlocking the potential in the Deputy's suggestion is the unique health identifier. I have asked the e-health people in the HSE to look at the Deputy's suggestion in that context. The next step in any reform of waiting lists is putting in place the unique health identifier so we can establish exactly how many times people appear on waiting lists. At present, nobody knows if a patient is on a waiting list multiple times for multiple doctors because the health service lacks the ability to identify individual patients. The unique health identifier is due in 2017 and is a really important element. I will keep in touch with the Deputy about this matter.
In response to Deputy Durkan, the primary care centres are very important but not if we just consider success to be bricks and mortar. It is what happens within the primary care centre that matters, which is why we need a new GP contract. Access to diagnostics is a huge piece. I want to work with the Department of Finance to fulfil a commitment in the programme for Government to see how we deliver diagnostic equipment in the community.
