I propose to take Questions Nos. 293 to 295, inclusive, together.
Scheduled care activity was significantly impacted in 2020 by the necessary decision, in line with National Public Health Emergency Team (NPHET) advice to defer most routine elective care appointments and procedures in March, April, and May last year. As a result of the significant disruption in services, hospital waiting list figures at the end of December 2020 were higher than at the start of the year, with the Inpatient / Daycase waiting list 9% higher than at the start of January last year, the Outpatient waiting list 10% higher and the G.I. Endoscopy waiting list showing the greatest percentage growth with a 46% increase. However, the rate of patient referral on to the GI. Endoscopy waiting list declined by just 1% year on year compared to a drop of 13% and 20% in referral rates for IPDC and OPD respectively.
As a result of the deferral of scheduled care, waiting lists reached a peak in May with 86,946 patients waiting for a procedure. With the resumption of scheduled care in June, the HSE took steps to improve patient pathways in the context of the pandemic and infection control measures, and worked to secure new routes to treatment. For example, the HSE sought to optimise productivity through alternative work practices such as telemedicine and the use of alternative settings including private hospitals, community facilities and atypical outpatient settings. As a result of this concerted effort, and supported by the work of the National Treatment Purchase Fund (NTPF), the waiting lists for the top ten high volume Inpatient/ Day Case procedures continued to improve from May 2020 onwards, though it is recognised that some procedures were either slower to recover or are more challenged. More specifically, while by the end of December 2020 cystoscopies, skin lesions, and laparoscopic cholecystectomies had not returned to pre-Covid numbers, it is of note that the number of patients on waiting lists for cataracts, hips/knees, tonsils, septoplasties, dental maxillofacial, and veins had almost returned to pre-Covid figures, if not slightly better.
The work of the HSE to improve access to elective care and reduce waiting times for patients is supported by the NTPF, who in 2020 reviewed strategies to maximise activity and benefit for patients. This included increased use of private hospitals, funding weekend and evening work in public hospitals, funding “see and treat” services where minor procedures are provided at the same time as outpatient consultations, funding hybrid services where public and private hospitals contribute to the treatment of patients, virtual clinics and clinical validation.
At the 16th of December 2020 the NTPF had arranged 31,615 IPDC treatments and 11,504 G.I. Scopes. In terms of Outpatients, the NTPF had approved in principal 70,297 Outpatient appointments. The NTPF was also sanctioned to provide additional diagnostic supports through Emergency Department Authorisation Notifications (EDANs), which allow sites to access available diagnostic capacity in both the public and private sectors to a value of €4m.
€240 million has been provided in Budget 2021 to fund access to care, €210m of which has been allocated to the HSE and a further €30m to the National Treatment Purchase Fund for the provision of treatment as required in both private and public hospitals in order to address capacity issues in acute hospitals and waiting lists.
On 2nd January 2021, the HSE issued correspondence to the Acute hospital system advising of the need to curtail routine scheduled elective care. This decision was made arising from the rapid increase in Covid-19 admissions and the projected trend in admissions based upon community transmission levels of Covid-19. The HSE recommends that only critical time dependent elective procedures are undertaken due to the on-going and significant increased demand for bed capacity related to Covid-19.
Following the termination of the original private hospital agreement in June 2020, the Government mandated the HSE to seek to agree with the private hospitals a new arrangement which would provide the HSE with access to private hospital capacity to include a safety net arrangement for any further surge of Covid-19 cases. The HSE has agreed a new safety net arrangement with all 18 private hospitals to deal with the current surge in Covid-19 cases and any further surges in the pandemic, if they arise within the next 12 months. The agreement provides that the HSE can access up to 15% or 30% of the private hospitals’ capacity depending of the incidence of the disease in the community or the number of Covid-19 positive patients in general or ICU beds in public hospitals. The private hospital capacity obtained by the HSE is being used to free up capacity in the public hospitals, mainly for urgent, time-dependant and complex care.
In relation to contingency planning for a post Covid-19 scenario, my Department, the HSE and the NTPF are continuously reviewing waiting lists with a view to ensuring that services for scheduled care are resumed as soon as it is deemed safe to do so in line with HSE clinical guidelines.