Vol. 404 No. 8
6 Mr. R. Bruton asked the Minister for Health if he will outline the areas of elective surgery where patients seeking public hospital treatment, experience the longest waiting times; and the way these times compare to the waiting time he would regard as acceptable.
I have explained on many previous occasions that waiting lists have always been a feature of all health care systems throughout the world and this will continue given the infinite demands which will be made on finite resources. We are fortunate to live in an age when better health care has resulted in longer life expectancy and when the success of new techniques and forms of treatment has improved the quality of life for many patients. This has led, however, to increasing demands being placed on the health services with a consequent effect on waiting lists and waiting times. I have placed great emphasis on tackling waiting lists over the past few years. Waiting lists in Irish hospitals in most specialties are not excessive.
Certain areas were, however, identified as requiring special attention. The Deputy will be aware of my concern about the problems which had arisen in the provision of cardiac surgery, ear, nose and throat procedures, cataract and hip replacement operations and will also be aware that additional funds were made available in 1989 and 1990 to reduce waiting times in these areas. The effects of the additional funding were clearly seen towards the end of 1989 and throughout 1990.
The present waiting times for the specialties mentioned depends on the medical condition of the patient. Waiting lists are kept under regular review by consultants. Each patient is assessed having regard to the particular circumstances of the case and priority is given according to medical need.
Would the Minister not agree that as TDs we daily receive reports of waiting times from 12 to 18 months which by any stretch of the imagination is unacceptable? Now that the Minister is dividing public and private medicine would he not agree that it is time to set down minimum standards that people could expect and that there are waiting times beyond which he will not permit people in need to wait?
I accept what Deputy Bruton has said. We did receive complaints about waiting lists in the particular specialties to which I have referred, for example, ear, nose and throat procedures and hip operations. I am glad to inform the Deputy that in Temple Street Hospital — a major supplier of ear, nose and throat services — the waiting list decreased by 58 per cent last year and the number of hip procedures at Cappagh Hospital was increased by 40 per cent last year. There has been a very substantial increase in the number of procedures being provided. They are not waiting——
They could not wait any longer.
Questions have been asked, let us hear the Minister's reply. Deputy Jim Higgins is offering.
Would the Minister not acknowledge that the percentages of alleged improvements matter very little to individual cases? I have here a reply from the Western Health Board to representations made on behalf of an elderly person.
I am sorry Deputy Higgins, I thought the Deputy would be aware that quotations at Question Time are out of order.
I will not quote from the letter. I am merely saying that this is a letter I received, the basic text of which is that this elderly pensioner, at 72 years of age, must wait 12 to 15 months before she can have her sight restored. Would the Minister not accept that a basic cataract operation is one that can and should be provided and should be a fundamental part of any healthy health system?
Deputy Higgins has alluded to an individual case, but the point I am making is that there has been an improvement in the level of activity in this area. As Deputies are aware, an extra £15 million was provided in 1989 and targeted specifically at the area of long waiting lists. This was continued for all of 1990 and had a major impact on the delivery of service. I would be glad to investigate any individual case for the Deputy but I cannot give him an answer here and now in relation to a specific case. I can tell the House that Deputies came in here month after month to Question Time and highlighted individual cases of people who had to wait four years for hip replacements in areas where the waiting time for hip replacements was nine months.
(Carlow-Kilkenny): I am always fascinated by the Minister's replies. I should like to know what 40 per cent means because 40 per cent of very little can be nothing. The Minister is selective in history; if he were to go back to the foundation of this House he would see that there were massive increases in wages and inflation since then. Is it fair that anyone in need of a serious heart operation should be told that it will be almost two years before he would be accepted, and in the meantime he should try not to get excited? Is it fair that his neighbours should have to rally round and collect money to enable him to have an operation? Last week I was in touch with the hospital about a prostrate gland and I was told that nothing could be done.
Deputy Browne has made his point effectively.
(Carlow-Kilkenny): Is the Minister dealing in fact or fiction in regard to these delays? Are these delays theoretical or practical.
I will deal with the points raised by the Deputy. It is unacceptable that people have to wait. It is unacceptable to me as a doctor that people have to wait for service. My whole philosophy is that people should be able to get the service they need immediately. It is unacceptable to me that a person with a pain in their hip has to wait three weeks. The reality is — and Deputy Browne referred to the foundation of the State — that at the foundation of the State there were waiting lists. There are waiting lists in every country of the world. For example, in Northern Ireland, which has half our population, the waiting time for an open heart procedure is twice as long as here. That is a fact of modern life. We are improving the facilities all the time. The 40 per cent I am talking about in one hospital is quite substantial — 220 operations; the target was an extra 200 but they carried out 220 operations.
It is obvious that the Minister recognises that the financial allocations are not sufficient and are not what he would wish. Does he intend to increase the allocation to health boards?
As the Deputy is probably aware a number of the health boards have requested a meeting with me. At this time each year, following such a request, I meet the chairman and the chief executive officer of the health boards — I have already met two this week — and we discuss how they might live within their allocation. As I said earlier at Question Time, the cost of drugs and value for money are two areas we have discussed with them.
Would the Minister not agree that his new proposal in relation to acute beds will put an additional strain on waiting lists which he accepts are unavoidable and unacceptable? If we put this additional strain on them that will be unacceptable too. We have a dilemma because we want to bring out the truth. It is up to the Minister to reply and he has not convinced me that anything will be done about the waiting lists; in fact the contrary is true.
I presume Deputy Ferris is referring to the new change in eligibility. The reality is that it will free up more public beds for public patients.
They are not there.
They are there but some are being used by private patients, a larger number in certain disciplines. After 1 June it will not be possible for private patients to take up public beds. That is the reality of what eligibility will do. This was recommended by the commission on funding, by NESC, the Congress of Trade Unions and the social partners, all of whom agree it is in the best interests of the people.
If you have the bed.
Only the Deputy and his leader seem to have a variation on that.
Deputy Paul Connaughton and Deputy Creed are offering. I want to facilitate the two Deputies if they will be brief.
May I put a question to the Minister?
We cannot remain unduly long with any one question. It is clearly to the disadvantage of all other questions and all interested Deputies.
I am speaking about disadvantaged people. The Minister referred to people in pain. Does he believe there is a reasonable medical service if a number of persons have to wait 13 months for hip replacement operations? Is it reasonable that a person should have to sell the shirt off his back to raise funds to have the operation? Is it reasonable that, irrespective of where he got the money for the operation, he would pay for it rather than use his medical card because he believes if he cannot pay he will never get to the operating theatre? Does the Minister think that is a good health service?
As I have already said, I would like to think that it would be possible, if not this year then at least at some time in the future, for people in pain to get immediate relief. That is my basic philosophy.
They are not getting such relief.
No country has been able to do this because as you increase the supply, you increase the demand. To again take Northern Ireland as an example, funding was provided there to eliminate a waiting list of 800 for hip replacement operations but within three months there were 800 on the waiting lists again.
If you pay for the service you will get it but if you do not pay you will not get it.
Deputy Michael Creed for a final brief supplementary.
It is not a question——
Please, Deputy, be fair.
During the 1989 general election campaign the Taoiseach said he was unaware of the crisis which existed in the health service. May I ask the Minister therefore, why a directive has been issued by his Department to health boards advising them to reduce their services and activities to 1989 levels? The implications of such a reduction in 1991 in the Southern Health Board area are 1,000 fewer elective surgery operations in Cork Regional Hospital, 700 fewer elective surgery operations in Tralee General Hospital and a pro rata reduction in all forms of elective surgery in the general hospitals in the Southern Health Board region.
Let us have finality.
The statement made by the Minister in the House today that there will be no cutbacks and the directive issued by his Department asking health boards to reduce their services to 1989 levels are incompatible.
No directive was issued by my Department to anyone asking them to reduce anything.
It was issued.
The health boards were told that they were being funded for the approved 1990 level——
They were told——
Please, let us hear the reply to the Deputy's question.
——which is exactly the same as the end-1989 level. As I have already told the Deputy, there was increased activity last year due to the major 'flu epidemic. There is no evidence to suggest that this epidemic will be repeated this year. I am being careful in case there is an epidemic, although all the evidence shows that there will not be one. If the commentators in the Southern Health Board were as careful, perhaps it would not be necessary to have a reduction of 1,000 in the level of activity in Cork Regional Hospital. I should like to know who knows what the level of activity in Cork Regional Hospital will be this year. Nobody knows; we must wait until 31 December.
Judge by the past.
Question No. 7, please.
