The Health Service Executive outpatient waiting list initiative was introduced at the end of 2013 for patients who had been waiting more than 12 months who were referred from public to private hospitals for outpatient consultant appointments and treatment. What is the position on the treatment of these patients? It has come to my attention in recent weeks that many of these patients have been told they will no longer be able to continue their treatment under their current consultants and that their files have to be returned in order that they can rejoin the ever increasing outpatient waiting lists at their original hospitals. For example, a young mother, whom I will call Caroline, was referred by her general practitioner in January 2012 to Letterkenny General Hospital for an outpatient appointment with a consultant gynaecologist. Two years later, in January 2014, she was referred under the HSE outpatient waiting list initiative to a private hospital for that consultant appointment, which she attended in March last year. The consultant diagnosed her as requiring surgery. She has been waiting for follow-up treatment since. Last week she received a letter informing her that, unfortunately, the hospital had been instructed by Letterkenny General Hospital that her treatment could no longer continue there owing to financial constraints. The hospital returned her file for ongoing treatment to be carried out within the public sector. The hospital apologised and stated it was completely out of its control. It stated that if she would like to continue her treatment there, she could do so privately and that it would provide a costing for it. Three years after her initial referral she is being put back on the waiting list from which she was referred. There are 1,300 patients in the same situation in Letterkenny General Hospital alone who are unable to have their treatment completed as planned. They are being put back on an ever increasing waiting list from which they had been removed. How many patients are in this position nationally? Will the Government decide to provide the funding required to allow them to complete their treatment, rather than send them back and add them to ever increasing waiting lists in public hospitals?
Leaders' Questions
I thank the Deputy for raising this issue. Obviously, I am not aware of the details of the case he has raised. In the case of Caroline – I think the Deputy said that was her name - he would want to make detailed representations on the specifics of the case to the Minister. I am not in a position to respond here and now.
The Government is committed to reducing numbers on waiting lists for scheduled care, concentrating particularly on those who are described as being a long time waiting, that is, over 18 months. The lady mentioned would fall into that category. The Minister for Health has asked the HSE to develop an action plan to deal with waiting lists, concentrating on those who have been waiting more than 18 months. The plan is to build on work under way and will be available in a few weeks time.
The HSE has also committed in the 2015 service plan to the publication of a waiting list of consultants and at specialist level and aims to reduce waiting lists by redesigning the processes and the way applications are treated. It has put in place specific measures to address waiting lists more efficiently in collaboration with acute hospitals, the special delivery unit and the National Treatment Purchase Fund They include observation of the national waiting list protocol, adherence to clinical programme guidelines and prioritising day of surgery admissions where clinically appropriate.
In the case of elective surgery, the HSE will work on implementing the recommendations made in the Comptroller and Auditor General’s report on day surgery in consultation with the national clinical programme for surgery, with specific reference to targeting increases in day surgery rates in line with best international practice. The waiting list performance will be assessed within the revised accountability framework for the HSE published as part of the service plan. New patient care pathways such as medical assessment, minor and local injury units and urgent care centres, as well as the provision of care in non-hospital settings, are increasingly being used to provide for a spectrum of care which supports the efficient use of hospital resources.
I am not in a position to comment on the details of the case of the lady mentioned-----
Where is the Minister for Health?
By way of a direct query, the Minister for Health would deal with the specific case mentioned.
He is asleep. There were 500 patients on trolleys again yesterday.
He is sleepwalking around the place.
I am not happy that we are not meeting all of the targets set, but it does mean that three out of four are receiving treatment within the target times and that there is significant investment in the development of better practices in order that, in particular anyone, such as the lady referred to, who has been waiting over 18 months, will be dealt with.
The Tánaiste did not answer any of the questions I put to her.
Surprise, surprise.
I did not ask about the Government’s plans, although they are important. I asked specifically about the HSE outpatient waiting list initiative, a previous plan of the Government, which was introduced at the end of December 2013 and through which I have no doubt thousands of people across the country were removed from hospital waiting lists to massage the figures to make them look good. They would have been referred to private hospitals with the intention, as they were told at the time, that their treatment would continue and be completed there. Caroline is but one example of 1,300 who are in the same position in one hospital. How many are in her position nationally? I have made representations about her and thousands of others.
I have taken up the matter with the Minister for Health. In a response to a parliamentary question last week which he had referred to the HSE the answer I received was that it was the HSE's intention that these patients would receive their treatment in a timely fashion in the hospital to which they had been referred. The funding required for it to proceed with this plan was not provided; therefore, it is now taking steps to add these patients back to the public waiting lists for ongoing management and treatment. It is in the process of communicating with these patients to provide for them accordingly. That is what I am asking the Tánaiste to explain. There are 1,300 cases in County Donegal. I have no doubt that on the street next to the Tánaiste’s there is a patient and that there are many patients in her neighbourhood in the same position. Is she aware of this case?
I am not aware of it.
Will the Tánaiste tell us how many are in this position of having their files referred back? Will she commit to providing the funding these patients were told would be available to complete their treatment under the consultant who is currently treating them?
The Deputy is already in discussion with the Minister for Health of the details of the cases mentioned. I do not have the details of all the numbers which would be available to the Minister for Health.
As I said, the Deputy should continue to discuss it with the Minister who has the details.
Will the Tánaiste take up the matter with him?
It is the Tánaiste's initiative.
The Tánaiste has the floor.
On waiting lists, the number of inpatient and day cases at the end of November 2014 was 61,000, of which 12,500 had exceeded the target waiting time of eight months for a procedure-----
That figure does not include the thousands about whom I am speaking who were removed from waiting lists.
-----while the cases of more than 2,000 children had exceeded the target paediatric waiting time of 20 weeks for a procedure. As I said, three out of four receive treatment within the target times. However, that is not satisfactory and it is the job of the Minister for Health to improve it.
There are thousands of people who are not receiving treatment.
In 2014 the number of patients waiting in excess of 12 months for an outpatient appointment was over 55,000. Again, while I am not satisfied with this, it does mean that approximately 85% of outpatients were waiting less than 12 months for an appointment.
The Tánaiste is massaging the figures. They are not accurate.
Up to the end of November, there had been a 3% increase in outpatient attendances, as compared with the figure for 2013. This means that 98,000 more patients were seen. The reality in the health service is that the vast majority of patients are being seen. I agree with the Deputy that for anybody who has been waiting a lengthy period to be seen, it is distressing and that changes to their care treatment plan may be very difficult for them. I will take up the matter with the Minister for Health on the Deputy's behalf.
The homeless crisis continues to spiral out of control. Every day families with children and single people continue to present as homeless. Rising rents, increased repossessions and the lack of social housing are forcing scores of adults and hundreds of children out of their homes. Following the tragic death of Mr. Jonathan Corrie in December, the Government press office went into overdrive in announcing measures which it was stated would stem the crisis. Today we learn that despite the provision in Dublin of an additional 300 emergency beds, there is still no spare capacity. Some 1,692 adults were sleeping in emergency accommodation in Dublin on New Year's Eve, the highest number in years. The problem is now so bad that there is a waiting list for family emergency accommodation in Dublin. As many as 80 families, with hundreds of children, are waiting to be placed in emergency accommodation, some of whom have been waiting for accommodation for months. In some cases, they have been forced to squat in homes when their notice to quit expired. They are being forced to sleep in cars or split up for days, weeks or months, with children being separated from their parents. They are being forced into low threshold hostels or hotel rooms, which environments are totally unsuited to children.
Despite all of the Government's high profile announcements, it is failing to stem the flow of families into homelessness. What families at risk of homelessness want to know is when will rent controls be introduced. When will adequate emergency accommodation be provided, including family accommodation, for those who are homeless? When will the Government start to release the promised funding for local authorities to commence construction of the homes that communities so desperately need?
The Deputy will be aware that prior to Christmas, the Government launched an action plan to address homelessness. As discussed previously, not all of the beds provided were taken up before Christmas. However, once the new year arrived, there was a significant increase in the take-up of these beds. Under the action plan, an additional 271 beds were put in place. The number and availability of emergency beds continue to be closely monitored, particularly by Dublin City Council within the area of which the bulk of emergency beds are provided.
There are no beds available from Friday to Tuesday.
As per the Minister's commitment, additional beds will be brought on stream should the need arise. The Government shares this commitment. The Minister recently updated the Cabinet on how the protocol had worked. I take the opportunity to pay tribute to all of the voluntary and advocacy organisations which worked on this issue with officials of the local authorities and the Department. I am sure the Deputy is aware that the teams dealing with the emergency housing and homelessness problems have been meeting on a regular basis to review what has been achieved under the pre-Christmas initiative. Initiatives such as the night café and transport provision have been very successful. In recent weeks I have been engaged in discussions on the problems that have arisen in some hostels. I understand the Deputy who raised the issue has been in contact with the manager of the homeless services about the specific situation that arose.
The Government is determined, should additional capacity be required, to provide it.
It is required.
As I said, once the new year arrived, the number seeking a bed increased. This was not the case before Christmas, at which time some people, including in the media, were talking about vacancies. Should additional capacity be required, it will be provided.
Deputy Mary Lou McDonald also asked about the provision of additional accommodation and the protocol in this regard. The needs of a significant number of people, particularly families but also including individuals, have been addressed under the protocol. As part of the budget, an ambitious €2.2 billion investment in housing was announced. Detailed regular meetings are ongoing between the Dublin local authorities and the Department of the Environment, Community and Local Government on the implementation of the social housing investment plan which is under way.
Two of the Tánaiste's remarks were very revealing in terms of the Government's attitude and approach to the housing and homelessness crisis. First, she said the Government would commit to doing more "should" additional capacity be required. Lest she and her colleagues in government are unaware, there is an absolute and urgent need for additional capacity. As I set out, this is particularly the case in respect of families with children who find themselves homeless. I have spelled out - I hope the Tánaiste was listening and heard me - the circumstances in which many families find themselves. In some cases, parents sleep in their car, while their children stay on either side of Dublin city with relatives or friends. Some families have been in this situation for weeks and others for months. There is no "should" in this equation. It is an imperative and a must.
Second, there is the Tánaiste's reference to beds. Of course, there is a need for emergency beds and to address the phenomenon of rough sleeping, but what people need, particularly families, are homes. This is about houses, permanent accommodation to allow people the certainty and dignity of having a roof over their heads. Far from being blameless in this scenario, the current crisis is of the Government's own making. Let us look at its record. Despite all of the recent announcements, since taking office, the Government has cut funding for social housing by 25%.
A question, please.
The Government introduced the Land and Conveyancing Law Reform Act in 2013 which has led to a tenfold increase in the numbers of repossession cases lodged with the courts. The Government has failed to get the banks to meet their mortgage lending targets. It has failed to control the spiralling costs of rent because it will not introduce rent controls. It has failed to invest in appropriate emergency accommodation, especially for families. That is the Government's record. No amount of activity or propaganda from the Government's press office can change that.
The families waiting for emergency accommodation, those on the homeless lists and those not on the homeless list but who have to sleep in the box room of their mother’s house with their three kids - I am sure we all meet them at our constituency clinics - want to know when the Government will take a hold of these matters and fulfil its responsibilities. They want to know when the Government will produce the funding for social housing. The local authorities still have no word as to what their housing budgets will be and will not know until March or April, an outrageous situation. What is the Government going to do in the here and now? I am not talking about press releases or propaganda but action.
The Deputy has asked three separate questions. First, she asked about homelessness and the pre-Christmas initiative for those who are homeless and using emergency hostel accommodation. In all fairness, I answered that question. I said that before Christmas not all of the beds were used but, once the new year arrived, they were. I also said should more beds be needed, they will be provided. I gave a commitment to the Deputy as did the Minister and the Government. That has nothing to do with public relations. Most of us know the people in question have difficulties in their personal lives, issues around substances and, in some cases, mental health issues. In all fairness, I answered the first part of the Deputy’s question.
She then added two supplementary questions, one about families. Since the protocol in operation with organisations such as Threshold has been initiated, it has assisted 400 families in getting or retaining accommodation. To emphasise for anyone listening to this debate, if a family or an individual fear they are at risk of becoming homeless because, say, the landlord may have raised the rent, if they contact Threshold, their local authority or their community welfare service, they will be able to discuss what appropriate assistance can be given. I already said to the Deputy that I sat down last week with staff from my Department to assess how the protocol is working.
Will the assistance be given? I have three cases.
They go to the local authorities and they are out on the waiting list.
The Deputy asked questions and, in all fairness, I have given her the answers.
Her third question was on rent control. The Minister for the Environment, Community and Local Government, Deputy Alan Kelly, is reviewing it to see if it is possible to bring in rent certainty into how rents are structured, a move which I strongly support. This is detailed work which will require levels of regulation and possibly legislation. There are landlords who are arbitrarily seeking to raise rents by very large amounts, way in excess of market prices.
Yes, most of them.
We have been talking about that for years.
I have listened to people suggesting raising rents is the way to deal with the issue. The Government has launched the largest ever social housing investment programme in the budget.
We are talking about today.
That will only provide 1,400 units.
The Deputy asked from where the money will come? The money has been provided in the budget.
No, the budgets need to be given to the local authorities.
The local authorities have to make detailed plans for social housing. Many Members were members of local authorities in the past and know the local authorities must identify the land on which social housing will be built. If that land is ready to go, then they have to bring those plans to the fore as quickly as possible and get building under way. That is what they have been tasked to do by the Government. I encourage Deputies from all parties to encourage their members on local authorities to support the construction of local authority social housing.
What have Labour councillors been doing for the past three years on those councils?
They have been doing more than Fianna Fáil councillors did for the past 20 years.
Labour will not have many councillors the way it is going.
Recently in Fingal County Council, some councillors, apparently on the left, voted against the provision of social housing.
Deputies
Hear, hear.
What about the developers who brought in a couple of hundred thousand euro to the local authority to help buy Deputy Finian McGrath out?
What about Deputy Finian McGrath’s deal with Bertie?
A Deputy
Finian bocht.
We have been told that Wexford will have an operational satellite dialysis unit in July 2016. Four years of delays in implementing this have led to significant disappointment in Wexford. As the Tánaiste may know, the Health Service Executive, HSE, intended to have such a service operational in Wexford by 2012. However, we were told this was not achievable due to a legal challenge by private dialysis providers to the tender award for the contracted satellite services in Dublin. A company called Fresenius Medical Care (Ireland) Limited, part of a €20 billion corporation, secured an injunction restraining the HSE from awarding the contract to another company, Beacon Medical Group. The dispute concerned the contract in Dublin but has impacted strongly on Wexford with a two and a half year legal battle and a four-year delay.
Meanwhile, 39 Wexford dialysis patients have to be taxied from Wexford to Waterford three times a week. When I queried the costs of this with the HSE, it informed me it costs €38,330 a month to taxi the 39 patients back and forth, €460,000 a year. Worse still is the incalculable cost to the well-being of the dialysis patients affected. The majority of these patients are in their 60s. I spoke to one of them recently, a man who is almost 80. He spends 400 hours a year, that is 50 eight-hour days, just travelling in a minibus from his home in Wexford to Waterford Regional Hospital for dialysis. His daughter Bernie told me her dad is collected at 10.30 in the morning, home usually at 7 p.m. with a five-hour dialysis session in between, Monday, Wednesday and Friday. This journey in a minibus in the cold and wet is tough for any individual. For many of Wexford's elderly, it amounts to abuse.
As the promised Wexford service was private rather than public, it has been held up by this injunction. There is something seriously wrong with the idea that a private company's action in court can have such an impact on the provision of a vital health service in Wexford. Does the Tánaiste believe this is good enough?
The generally accepted best medical standard for dialysis treatment is to have it as close to the patient as possible either through their local hospital or other local health services. In some cases, it is now possible to do this at home or in a local community-based facility. My understanding from what the Deputy said is that due to a legal challenge arising from a dispute between private operators, the operation of such a service in Wexford appears to have been delayed.
As it is subject to a legal challenge, and I do not have the background details of the dispute, I am not able to comment on it. The general principle is to develop the network of dialysis facilities around the country so as to be as close to the patient as possible. I agree with Deputy Wallace about the letter he received from the patient's daughter. For somebody requiring dialysis, it is very difficult to end up travelling a long distance over a long day to get essential treatment.
Regarding the provision of services in Wexford, my colleague, Deputy Howlin informs me that there has been an enormous focus on investment in services in Wexford. This is clearly a service which requires further development. Some years ago, when the service in Waterford was developed for much of the south east, it was considered very significant progress. I recognise that it would be much easier for people if that service was available locally in Wexford. As to the legal dispute which the Deputy suggested was material in this case, I am not party to that information. The Deputy may have to speak to the Minister for Health in some detail about it. I will also ask the Minister for Public Expenditure and Reform, Deputy Howlin, about it, because I know he has been involved for many years in all of the improvements to hospital services in Wexford which have happened and to which there has been a commitment.
The core of the problem is that we have a situation where a service to the public is delayed for four years because of a battle between private companies. The Tánaiste might clarify this for me as I do not know for certain, but it sounds to me like a version of a public private partnership, PPP. Sadly, we do too many things now through PPPs. When vital public health services are delayed for four years because we have chosen to go down the private route rather than the public, this is at the source of the problem. We should not be allowing these multi-million euro corporations delay much-needed services to public patients. It is ridiculous.
Regularly, the Government boasts that we can borrow money at 1.7%. Why have we not challenged EU rules so that we can borrow money at 1.7% and use it for infrastructure development, investment in health and other areas rather than being driven into the hands of the private sector in the form of PPPs?
Hear, hear.
The money ends up costing somewhere in the region of 15%, not 1.7%. The EU rules are forcing states to make private investors fat. That is what is happening, and we are not challenging those rules.
Exactly.
Surely the Tánaiste must agree that it is a crazy situation. We cannot have a situation like that in Wexford, where people are being driven to hardship while the State is not dealing directly with the challenges that are offered because of EU rules. Can the Tánaiste please find out if this is a PPP arrangement or a version of one? I do not expect her to have that answer now. Can she tell me whether she agrees that we should be challenging the EU rule that stops us from borrowing money at less than 2% to invest in public services and infrastructure and that instead drives us into the hands of the private sector in the form of PPPs?
As regards Ireland borrowing, the Deputy probably knows that this week, Ireland was in a position to borrow €4 billion on a 30-year basis, a very long-term basis for raising debt, at just around 2%. That is what makes us so different from other countries that are still experiencing enormous difficulties.
The Tánaiste will bring in the Greeks now.
What about dialysis in Wexford?
The country is in a position to borrow and, although there are limitations on the totality of the borrowing, €4 billion at just above 2% over a 30-year period - a very long maturity period - is an excellent way of providing funding for all the different projects, ranging from social housing investment to investment in our health and education services.
I am not familiar with the details of this legal dispute, so I do not want to comment on it. Nor do I know whether or not it is a PPP - it may well be. I broadly agree with what Deputy Wallace is saying. If it is possible to borrow much more efficiently and cheaply on the international markets - as we have done this week - and also to roll over a €9 billion portion of our previous IMF debt and re-borrow it at a much cheaper price - as we did before Christmas - that is certainly the way to grow national capacity in order to have the money for all the capital investments we require.
There may, however, be a role for PPPs. The Deputy is probably aware that Ireland has developed a very good model of bundling school and third-level education projects together. An agency like the European Investment Bank would not give us the €8 million or €20 million required for a small or medium-sized school but if we take a whole bundle of schools together we can get very advantageous rates, although not quite as cheap as what we borrowed this week. The Government has been using that mechanism widely. There are a number of different mechanisms.
I agree with Deputy Wallace that it depends on the terms, rates and conditions, but I do not want to comment on the specific case. I will ask the Minister for Health to give me some information about the cases the Deputy has raised. I fully accept his proposition that it would be so much better for this man - I understand it is a man in this case - to be able to get the dialysis services he needs as close as possible to where he is living. As Wexford Hospital is a very fine hospital, I hope that in due course it will be available there for him.