I move:
That Dáil Éireann:
notes:
— that more than 660,000 people are on a hospital waiting list;
— that there are in excess of 100,000 outpatient appointments outstanding for over a year as of May 2017;
— the establishment, in January 2015, of maximum permissible waiting times for inpatient/day case treatment and outpatient appointments of 18 months by 30th June, 2015 and 15 months by the end of 2015;
— that these targets were not met and still have not been met;
— that 46,629 outpatients were on the waiting list for more than 18 months in April 2017; and
— that 5,770 patients were on the inpatient and day case waiting lists for more than 18 months in April 2017;
further notes:
— the very great distress and pain being suffered by people enduring long periods on hospital waiting lists;
— the fact that the long waiting times are further exacerbating the clinical conditions needing treatment thereby producing more pain and suffering; and
— that such long waits are not only intolerable and excruciating for the patients, they are also counterproductive and a waste of health service resources and lead to poorer clinical outcomes and increased mortality;
recognises:
— the deplorable and dangerous overcrowding that continues to be experienced in hospital emergency departments;
— the record number of patients waiting on trolleys, particularly the frail elderly, during the first four months of 2017;
— that such overcrowding results in further delays in scheduled hospital treatments and essential surgery, thereby further worsening the waiting lists; and
— the comments by the Director General of the Health Service Executive, HSE, that should the trend in presentations to emergency departments continue that all work will be emergency work and hospitals will be unable to accommodate elective work; and
calls on the Government and the HSE to:
— hold each hospital chief executive accountable for the open disclosure of accurate data on waiting lists in each hospital;
— make transparent to the public the monthly progress from each hospital on waiting list figures, giving specific detail on outpatient waiting lists, access to diagnostic waiting lists and elective surgery lists;
— ensure each hospital group present monthly updates on waiting list progress of each hospital in their region, making transparent the difference between those patients awaiting a clinical procedure or elective surgery or an appointment to be seen in an outpatient clinic;
— ensure that each hospital review the scheduling and utilisation of outpatient clinic space;
— ensure that each clinical director meets with each and every consultant providing outpatient clinics and elective treatment, to examine the scheduling of clinics and procedure lists to match scheduling to demand;
— schedule elective diagnostic investigations seven days a week;
— schedule elective surgery seven days a week;
— open without delay all ward beds that have been closed;
— expedite the bed capacity review and expand it to include a review of outpatient clinic capacity and utilisation;
— examine the potential for hospitals without 24/7 emergency departments to increase their elective work;
— direct the National Treatment Purchase Fund (NTPF) to publish all other waiting list data on a monthly basis as per the criteria used in the waiting lists currently published;
— immediately provide scheduled procedures under the NTPF and maximise the use of private capacity in this regard;
— utilise the existing community hospital network more efficiently to help prevent admissions to acute hospitals by facilitating direct admissions by general practitioners to these facilities, to facilitate post-operative discharges from acute hospitals and to work as an interface between the acute sector and the Fair Deal Scheme; and
— commit to upgrades of the community hospitals network to help alleviate pressure in general hospitals.
The motion is timely in view of the fact an Oireachtas all-party report was published today on the delivery of health care over the next ten years, changing how it is delivered and the need to fund it accordingly. In adjudicating on the success or failure of the health care system in recent years, it must be said there has been a fundamental failure on every matrix on the part of Government to deliver in a meaningful way in the key areas where there are huge difficulties, which are primarily emergency departments and hospital waiting lists. Some 660,000 people are on hospital waiting lists of one form or another. That is a sad indictment of the failure of the system to deliver in a timely fashion.
We saw this in a personal way when watching "Living On The List", the RTE Investigates programme broadcast earlier this year. It showed the impact of the delays on people's lives. That is something this side of the House has failed to highlight but, more importantly, it is something the Government has failed to address, by putting mechanisms in place to ensure people are not waiting inordinate periods for inpatient, outpatient or day-case appointments. The reason we tabled this motion is that we still believe the issue is not being responded to in a timely manner by the Government.
People will say the Government was waiting for the publication of the report of the all-party Oireachtas Committee on the Future of Healthcare. That probably gives a certain amount of cover to people who have no policies in the area of health care. However, and I hate to highlight this consistently, over the past six years Fine Gael has been bereft of any policy direction for the delivery of health care. For the first three years of the previous Government's term we spoke about universal health insurance as the model to be adopted. It was the major policy plank for funding health care in future years. Of course, it was never costed and there was no analysis of how it would be compatible with Ireland's health care system. There was no detail whatsoever in the proposal. We spend three years faffing around on whether it could be implemented. Behind the scenes, it was slowly let wither on the vine. It was eventually put out of its misery in 2014.
Since then there has been no genuine focus on the key areas of the waiting lists and the emergency departments. There are many reasons for the waiting lists, including a lack of capacity, a lack of consultants and a lack of overall coherence in assessing who is on a waiting list and in making people, both clinical and administrative, accountable for waiting lists to ensure there is proper oversight and governance in the delivery of health care. Last year, in the context of the negotiations that took place on the supply and confidence agreement, the issue of the National Treatment Purchase Fund, NTPF, was raised. A sum of €15 million was to be put aside for it and it was to be included in the 2017 Estimates. Subsequently, there has been no movement in terms of people being treated by the National Treatment Purchase Fund. At the end of May 2017, we have not seen any meaningful processing of people through the system. That is a sad indictment given that, since last June, it has been part of the supply and confidence agreement and of the programme for Government to ensure there are timely interventions for the longest waiters. That has not happened. It is very disturbing. The system should have been able to assess who has been on the waiting list the longest and who should be prioritised for treatment or consultation.
I ask the Minister to revisit this issue as a matter of urgency and to impress on the National Treatment Purchase Fund the urgency of its deliberations in terms of finding those who will be contracted to provide the services for the longest waiters. There is also a commitment that next year there will be an increase in funding for the National Treatment Purchase Fund. The reason we sought the funding for the NTPF is that the fund has been the mechanism that has been used most effectively as a safety valve, until it was cancelled by the previous Government, due to a lack of capacity in the public health system. I acknowledge that lack of capacity in the public health system. However, it is unacceptable that at the end of May 2017, the National Treatment Purchase Fund has not been taking patients off the waiting list, given that this was included in the supply and confidence agreement this time last year.
The motion is quite straightforward. It highlights some of the inadequacies in the health system and recognises the conditions being experienced by patients and staff across emergency departments, in particular the treatment of some elderly people which has been well documented. There appears to be a lethargic acceptance within the system that these things are okay. If there are 370 people on trolleys, it is no big deal. No one appears to get excited about it anymore. Some people wait for inordinate periods on trolleys. Until the figure hits 600, there is no interest in whether the system is even delivering safe health care in emergency departments. The matrix now is 600 people. We have allowed our standards and ambition to drop substantially. That was highlighted by the Minister's predecessor who effectively abandoned the waiting list targets that had been set and extended them to 18 months. Instead of trying to address the underlying concerns, the goalposts were moved. It was decided that it was now acceptable for people to spend 18 months on waiting lists.
I hope the motion receives cross-party support. It highlights the inadequacies but also calls for some tangible benefits on which I will elaborate later. I commend the motion to the House and I look forward to a good, proactive debate on it.