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Dáil Éireann díospóireacht -
Thursday, 26 Mar 1992

Vol. 417 No. 7

Ceisteanna—Questions. Oral Answers. - Hospital Waiting Lists.

Charles Flanagan

Ceist:

6 Mr. Flanagan asked the Minister for Health if he can give an assurance that no patient will be struck off hospital waiting lists without personal discussion with either the patient or his or her doctor to confirm that the patient's needs have been satisfactorily dealt with.

Richard Bruton

Ceist:

10 Mr. R. Bruton asked the Minister for Health if he will publish the results of his review of public and private waiting lists; and the date on which he plans to make this available.

Brendan McGahon

Ceist:

23 Mr. McGahon asked the Minister for Health if he will establish, in the survey on the review of the waiting list for hospital admission, the reasons patients have left the waiting list.

Michael Finucane

Ceist:

65 Mr. Finucane asked the Minister for Health if he will give details of the frequency with which he intends to publish information on waiting lists and waiting times for operations.

Mervyn Taylor

Ceist:

104 Mr. Taylor asked the Minister for Health if he proposes to take any steps to reduce hospital waiting lists; if so, if he will outline the steps involved; and if he will make a statement on the matter.

Richard Bruton

Ceist:

151 Mr. R. Bruton asked the Minister for Health if he will outline the summary information obtained from his recent review of waiting lists and in particular, if he will outline, (i) the total number of (1) public patients and (2) private patients on waiting lists and, in respect of each, the number waiting, (a) under three months, (b) three months to a year and (c) over one year, (ii) the total number of (1) public and (2) private patients in each of the following specialities, (a) ENT, (b) ophthalmology, (c) hip replacement, (d) other orthopaedic, (e) cardiac, (f) vascular and (g) plastic surgery and (iii) the number of (1) public and (2) private patients waiting over one year in each of these specialties.

Ivor Callely

Ceist:

160 Mr. Callely asked the Minister for Health if he will outline the total number of people awaiting hospital admissions to the Dublin hospitals; if he will give a breakdown of the list by age, gender and specialty; if a significant reduction in the waiting list for hospital admissions is expected following the recent up-dating of all hospital waiting lists; and if he will make a statement on the matter.

I propose to take Questions Nos. 6, 10, 23, 65, 104, 151 and 160 together.

The Third Report of the Dublin Hospital Initiative Group recommended measures specifically designed to achieve better management of waiting lists in acute hospitals in Dublin. These recommendations are of equal relevance to all acute hospitals in the country.

In December last, having considered the report, my predecessor asked that an immediate countrywide validation of waiting lists be carried out. I attach considerable importance to the validation exercise as I am particularly concerned to ensure that all hospital authorities should provide accurate, reliable and up-to-date information on in-patient waiting lists in order that action can be undertaken to tackle the most pressing problems in this area.

Waiting lists which are not routinely validated can give a distorted picture of the real demand for service. Studies have shown that a significant number of patients whose names are on waiting lists will not require treatment for a variety of reasons. They will have self-deferred, been admitted elsewhere, have moved house, or their condition may have improved.

Or died waiting.

In many cases the condition improves. The validation process which involved a bulk postal review of all patients on the in-patient waiting lists for over three months is as follows: each patient is written to, asking if they wish to remain on the list; where a reply is not received within two weeks or where the patient indicated they no longer wish to be treated the consultant concerned is asked to review the patient's notes and to approve the issue of a letter to the general practitioner advising that the patient's name will be removed from the waiting list unless the GP advises to the contrary. I am satisfied that this process provides proper safeguards to ensure that no patient is inappropriately removed from a list.

The majority of agencies have submitted validated returns at this stage. I have asked that those outstanding be submitted as a matter of urgency. The information will then be collated and examined and I will make the results available as soon as possible. The information being collected in the validation exercise will show the waiting lists for public and private patients for all specialties.

For the following specialties, more detailed information is being collected: ENT, ophthalmology, orthopaedics, cardiac surgery, plastic surgery and vascular surgery. The information will indicate the number of patients waiting from three to 12 months, the numbers waiting over 12 months and will also provide breakdowns for particular procedures in these specialties for adults and children where appropriate.

The health agencies have also been asked to put formalised arrangements in place for ongoing review and validation of all waiting lists and thereby ensure that comprehensive and reliable data on patients waiting treatment is readily available.

From the Minister's provisional returns, could he indicate whether he has evidence about the projected waiting time for public versus private patients, which is the key issue being collated? Will he publish these returns on a regular basis so that the House can examine progress and the speed in catering for the needs of different categories? Is he satisfied that a system which at no stage makes personal contact, other than by post, with a patient on a waiting list does not result in some people being forgotten? I can envisage people waiting for a cataract operation not being successfully communicated with by post.

We have no figures that can help the Deputy at present. I will press the hospitals concerned to make the information available as soon as possible and every Member will get a copy. That is important. I agree that this should be done on an ongoing basis so that we will know exactly how things are. Regarding communication, the letter to be sent out was prepared in consultation with a consultant in St. Vincent's Hospital. The Kennedy group were quite happy as a result of the medical advice on the matter that this was the best way to approach it. If a person does not reply he or she is not automatically taken off the list. We ask the consultant to discuss the matter with the general practitioner. Every effort humanly possible is made to contact the person. I have examined this matter and I cannot suggest a more effective alternative. When the results are publicised, anybody who feels that he or she may have been overlooked can make contact.

Would the Minister not agree that the correct way to set about reducing hospital waiting lists is not to undertake a barren exercise in validating the lists but rather to provide the degree of hospital services necessary to deal with these lists and to carry out the operative procedures and treatment for which many people have been waiting two years or more? The hospital budget is totally inadequate and these lists are getting longer all the time instead of shorter. What are the Minister's proposals to deal with the lists in that regard?

I do not agree with the Deputy and I will tell him why. Every rational person believes that validation is important because in many cases it was discovered that people who had been operated on had left the country. It is not possible to solve the problem by providing an unlimited number of forms.

Patients have died.

I welcome supplementaries from Deputies, but I would appreciate a little courtesy when I am replying. Many people are unnecessarily put on waiting lists. Cardiac surgery, especially coronary by-pass surgery, does not prolong life. Perhaps review committees should be set up in hospitals to see whether putting people on waiting lists is justified. Many people who are on waiting lists do not require urgent treatment. When a person is put on a waiting list anxiety develops and the patient thinks he will die if he is not treated. I am not trying to save money in this area. A similar problem arose when the Deputy's party was in power. More money does not necessarily mean better health. If we considered health services in a different way many waiting lists might not be necessary. Hip implants are very important because they help to mobilise people and get them back into society. We have an obligation to those people, but other operations might not be necessary and people might be better off without them.

As regards the validation of waiting lists, particularly in the Dublin area, is there an indication of an extraordinarily long waiting list with regard to any particular speciality or is there any indication that following validation there would be a significant reduction in the waiting period for the procedure to be carried out?

There are over 1,000 people on the waiting list for cardiac surgery. I invited the four cardiac surgeons to come to see me with a view to increasing the number of operations carried out. They listened very sympathetically to my proposal and agreed to carry out an extra 40 operations per year. In addition, a second cardiac surgeon will be appointed in Cork and some inroads should be made in that area. Ophthalmology is an important area because cataracts must be treated. This is an area where I would like to see more funds applied. In the treatment of ENT patients most cases require the insertion of grommets, which is not a very specialised technical operation. There will have to be an increase in this type of treatment although some doctors argue that many patients recover without the insertion of grommets. That is true with the proper treatment. The removal of tonsils is fashionable from year to year. If a member of the royal family gets his tonsils out everybody wants their tonsils out. When the removal of tonsils goes out of fashion people believe that tonsils are very important because they are part of the immune system and that they should not be removed.

Will everybody be looking for a divorce soon?

We should consider these matters in a more objective way. I believe that many patients needing grommets will have recovered by the time they are treated, but the treatment of cataracts, glaucoma and orthopaedics is very important and more funds should be applied to these areas.

I envisage that in 12 months time no additional resources will have been made available and the Minister will use the validation process as a yardstick for his stewardship. I accept that validation is necessary but it will not solve the whole problem. Would the Minister give a commitment to the House that he will in the validation process determine the number of patients who opt for private treatment because of the length of waiting lists for public treatment? Second, would the Minister not accept that validation would go only half the way towards solving the problem? Most people on waiting lists are waiting for out-patient appointments which would determine whether or not operations are necessary. It is in this area that huge delays occur. I would ask the Minister what steps he will take to ensure that the waiting time of a year and a half to two years for out-patient appointments with consultants is reduced.

I agree that many people are waiting for outpatient appointments and many have opted for private treatment because they felt that the waiting list for public treatment was too long. Measures have been taken to ensure that the private patient does not take precedence over the public patient. We have arranged lists for public and private patients and we have designated beds for public and private patients. I have examined the system and I admit that I am sceptical about it. I want to ensure that we do what is best. Many beds in public hospitals were never designated as public or private beds and private patients took up these beds. Now that we have designated a certain number of public beds we have to make sure that there is no queue jumping.

There is much dissatisfaction with this system and many people, particularly women who engage private obstetricians, want public beds. However, they cannot have it both ways. Public beds should be designated for public patients and private beds for private patients. If that system is adhered to there would be a much better result. I agree with the Deputy that validation would solve only half the problem. As Deputies know, the resources are limited and I am restricted in what I can do. I agree that many patients have jumped from the public queue to the private queue and I wish we could solve the problem in a simpler way. When lists are validated we will be in a better position to know how to tackle the problem. When I came to office all the resources had been allocated and the cupboard is bare.

What about the outpatient appointments?

Deputy Donal Carey.

Will the Minister answer the question about outpatient appointments?

I have called Deputy Creed's colleague and he should please facilitiate him.

Is the Minister aware that there is a difference between the validation letters issued to people in the city and those issued in the country? There is confusion in the country in that some people believe they are being taken off the list and they do not reply to the letter. There is a long waiting list for orthopaedic and neuro-surgery, but the Minister has not adverted to this in his replies. Surely the Minister is concerned about the difference between the lists in the country and those in the city.

Many people may be confused by the use of the word "validation" and we must explain it a little better to them. I am delighted to hear the Deputy's comments because they make me more aware of the problem. I referred to the areas in need of urgent attention, including orthopaedics, ophthalmology, ENT and cardiac surgery.

And neuro-surgery.

Yes. I answered a question on that matter earlier and said that I am concerned about the problem in Beaumont. The Deputy is right in that more publicity is necessary regarding validation. Many people may not have replied to the letters they received because they did not understand them. In considering that aspect I will pay attention to the Deputy's suggestion.

The progress at Question Time today has been particularly disappointing. We have dealt with only six or seven questions in 50 minutes and from any standpoint that is not good enough.

The information is very fascinating. If half the suggestions we have heard are implemented, the health of the nation will improve.

I appeal, even at this late stage, for brevity and for worthwhile progress.

Has the Minister not heard the phrase "separate but equal" somewhere before, when two categories of people were put on separate lists and which did not produce equality of the kind that would be expected? In relation to the issue raised by Deputy Creed, is it not the case that the huge waiting times before getting a first appointment with a consultant mean that many people do not get even to the starting line when waiting for treatment? Could the Minister clarify his statement that many people would be better off without operations? If that is so, how did those people get on waiting lists in the first place if they had been screened by GPs and consultants? Would the Minister perhaps be reverting to George Bernard Shaw's theory of medicine that a bag of greengages is the best treatment?

As the Deputy knows, doctors differ and patients die. I agree that the position in relation to out-patient appointments is far from satisfactory and people have to wait an inordinately long time. We have to try to speed up that process. The Deputy is correct; it is not good that some people do not get past the starting line. The Deputy asked me one other question. I suspect that perhaps Alzheimer's Disease is setting in; I have forgotten the other part of the question.

The Minister said that many people would be better off without the operations they are waiting for. How did those people come to be on the waiting lists?

As I said, doctors differ and patients die. I have been in family medical practice for many years. While I might advise a patient that he or she could live his or her normal life span without an operation, another doctor might tell the same patient that he or she might as well have the operation. I have worked both in hospitals and in medical family practice. I would not advise a patient to have a major operation for some minor disability when a high risk was involved, but other doctors might not agree with me. That is why I say that perhaps many patients would be better off without an operation. One man wrote to me through the Department in relation to an operation he was waiting for, an operation that would correct indigestion. The operation is major and I certainly would not recommend it to anyone. Another practitioner had suggested to the man that he undergo that operation and he now wants to know how quickly he might have the operation. My advice is that he should not have the operation. I should adopt a very pragmatic, sensible approach to the issue and not think that everyone should have operations.

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