Ceisteanna Eile - Other Questions

Hospital Consultant Contracts

Gino Kenny


68. Deputy Gino Kenny asked the Minister for Health the steps he will take to restore the services of a paediatric consultant that previously provided clinical paediatric oversight to the services in the National Rehabilitation Hospital but is now on long-term leave; the impact this has had in terms of closure of in-patient services for children; and if he will make a statement on the matter. [43452/18]

Deputy Gino Kenny is ill today so I am asking this question on his behalf. Six beds closed in the National Rehabilitation Hospital in Dún Laoghaire in August, meaning, scandalously, that 12 beds have closed in that hospital. The other six have been closed since the end of 2017 due to staff and other resource shortages.

In August, however, six paediatric inpatient beds were shut as a result of the inability of the consultant who works out of Crumlin hospital to provide paediatric cover because they apparently went on unplanned leave.

The National Rehabilitation Hospital, NRH, in Dún Laoghaire, Dublin, provides complex, specialist rehabilitation services to patients who, as a result of an accident, illness or injury, have acquired a physical or cognitive disability and require specialist medical rehabilitation. Services include a paediatric programme which is delivered by a paediatric team based on the campus with clinical oversight provided by a consultant paediatrician who is based off-campus at another hospital. Up until recently, this consultant paediatric oversight was provided by a consultant paediatrician at Our Lady’s Children’s Hospital, Crumlin, whose contract includes a seven-hour clinical attachment to the NRH.

I am advised by the HSE that the consultant paediatrician in question recently went on unplanned long-term leave and, arising from this unforeseen development, Our Lady’s Children’s Hospital is not currently in a position to provide consultant oversight to the NRH’s paediatric programme. In light of this, the NRH has reluctantly closed its inpatient paediatric service on the basis that it is not possible to appropriately assess and triage new paediatric referrals and medically manage paediatric patients without consultant paediatric input. The suspension of this service is impacting on existing inpatients, those on the waiting list for admission, and those who are newly referred to the services and are awaiting assessment by a consultant.

The Children’s hospital group has confirmed that officials are actively working to identify another consultant paediatrician with an interest in disability to fill the vacancy to provide appropriate clinical paediatric oversight to the services provided at the NRH. In the interim, the paediatric team at the NRH continues to offer outpatient and outreach services to children. The NRH and HSE will continue to work closely to seek a solution to this matter.

The NRH provides incredibly important services in brain injury, spinal-cord injury, prosthetic and limb absence rehabilitation, as well as paediatric rehabilitation. The human consequences of not having these beds open are severe. Today, I spoke to Deputy Gino Kenny's constituent who contacted us about this issue. The individual’s daughter had a brain tumour and surgery in Temple Street hospital in April. She has been left with serious weakness on her left side and needs serious rehabilitation. However, she is now unable to go to the NRH for treatment because of the closed beds. Early intervention in serious situations such as this is important. This is the human consequence of this.

Will the Minister of State explain why we cannot recruit a consultant to provide the cover which will allow these beds to be reopened, given the suffering endured by people who really need it? We need an explanation.

I welcome the Deputy’s comments on the great work the Children's hospital group and the NRH do. The reality is that we have an issue with consultant numbers. Earlier, we had a discussion about the problem with the shortage of doctors. That is a problem with which we are trying to deal. We have seen an improvement in recent months with the return of many people from abroad. I have seen this with speech and language and occupational therapy services. We still have an issue with staffing. We need more consultants.

The NRH remains committed to resuming its inpatient services as soon as the resolution to the current issues around the consultant paediatrician cover is found. The NRH and the HSE will continue to work closely to seek a solution to this matter. The Government recognises the excellent programme which the NRH delivers and its excellent patient outcomes. We have to deal with the issue of staffing on which we are strongly focused.

There is no doubt about the excellent work the NRH does. However, 12 beds were closed at the end of 2017. The hospital managed to get funding to get six of them reopened but then another six were closed because it could not get the paediatric consultant cover. If it is related, as discussed earlier, to the sort of apartheid new-entrant levels of pay for consultants as a result of austerity cuts, then it has to be addressed. This situation cannot go on with the girl I just mentioned who needs this rehab urgently, as well as the many others who need rehab. It is unacceptable.

We need to sort this out. We need to provide necessary resources to recruit the consultants to do this vital work.

I take the Deputy’s important points. We have to strongly focus on this issue.

The hospital has made a submission to HSE’s National Hospitals Office on the reopening of the six closed beds. The office supported the NRH submission within the context of the Estimates process for 2019. The HSE’s operational service improvement division has also sought to reopen the six beds for the winter planning process for 2018 and 2019. However, such considerations will only be concluded by October and November this year. If successful, the beds will be reopened after this date.

However, the HSE continues to liaise closely with the hospital on the bed capacity issue. I will strongly focus on this because I accept the Deputy’s arguments on the need for services for children with disabilities.

Disease Management

John McGuinness


69. Deputy John McGuinness asked the Minister for Health his plans to bring forward a Lyme disease strategy to help those suffering from the condition. [43600/18]

Writing in July 2018, Kerry Lawless outlined her experience of suffering from Lyme disease:

My life became this tiny thing. Someone who had worked hard, played hard, travelled extensively, loved large, lived life to the full. I became a shadow, housebound, a virtual recluse with one or two good friends to sustain me... I thought about ending it all.

There have been regular protests outside the gates of Leinster House about Lyme disease. What is the Minister doing to ensure this matter is dealt with?

I have received correspondence from the Deputy on this issue on which he has advocated strongly.

The Health Protection Surveillance Centre has a Lyme disease sub-committee which has been tasked with producing a report which covers awareness of Lyme disease among clinicians and members of the public; identification of best international practice in raising awareness about Lyme disease; development of policies for primary prevention of Lyme disease; exploration of ways in which to improve surveillance of Lyme disease; and the development of strategies to raise awareness of Lyme disease, particularly in areas of higher tick populations.

The Health Protection Surveillance Centre is aware that the National Institute for Health and Care Excellence in the UK has undertaken a systematic review of Lyme disease which resulted in the institute publishing new Lyme disease guidelines. These are based on the most exhaustive systematic review yet undertaken of the evidence around Lyme disease and focused on producing recommendations based on best available evidence relating to diagnosis, management and public awareness of Lyme disease.

The final report of the Health Protection Surveillance Centre’s Lyme disease sub-committee has been delayed to ensure the evidence presented in the institute's guidelines can be factored into its final report. It is appropriate we should learn from best international practice and experience.

The report should be finalised in November, at which point it will be sent for consideration to the Health Protection Surveillance Centre’s scientific advisory committee. At this juncture, it would be inappropriate to consider making changes to the testing, treatment and management of the condition until this deliberative process has been completed. I know people have been campaigning for recognition of the disease in this country. I hope when the report is finalised we can make informed decisions as to how we can improve treatment, awareness and diagnosis in line with other jurisdictions.

The Minister cannot ignore the words of Kerry Lawless when she stated, "I was worn out. Beat down. Broke. Defeated. I couldn’t face another ten years". If one listens to the reply he has just given, however, while work is ongoing, the campaign for the recognition of Lyme disease has gone on for years but little or nothing has been done.

While the Minister is waiting for the report, the fact of the matter is that in France the Government has a model of care and understanding of Lyme disease that could be copied by this country. No effort is being made to inform the public in any meaningful way. The only organisation I see doing this is Tick Talk, and Ann Maher writes to the Minister on a regular basis on behalf of the organisation highlighting the issues and the costs of going to Germany for diagnosis and treatment. It is extremely unfair that people in this country who have Lyme disease can, like Kerry Lawless, be left undiagnosed from 2007 to 2017. We are ruining the lives of people. Simple mistakes are being made and not being recorded.

My record on this is not one of doing nothing but asking that we update our scientific advice, not just based on our experiences and evidence but also looking at what has been done across the water in the UK. We will have the basis of information next month, which will enable us to make informed decisions in this regard.

Lyme disease can be very successfully treated in many cases using common antibiotics. These antibiotics are effective at clearing the rash and they help to prevent the development of complications. Antibiotics are generally given for up to three weeks and if complications develop intravenous antibiotics may be considered. Tick Talk Ireland, the support group referenced by the Deputy that does excellent work to encourage awareness, prevention and treatment of Lyme disease in Ireland, has requested that the guidelines produced by the International Lyme and Associated Diseases Society be used instead of those recommended in the 2012 consensus statement.

The Deputy is probably aware that on 25 September a meeting took place between the Department and members of the cross-party action group on Lyme disease. Tick Talk Ireland was represented at the meeting. I accept this is an issue on which there is an awful lot of concern. I accept the testimony the Deputy has given me from a person with whom he has been in contact. I hope that by this time next month we will have an evidence base on which to move forward.

I impress on the Minister the urgency of this. We tend to do an awful lot of reports and we do not learn from other countries. I have highlighted the fact that France seems to be leading the way but Canada has a similar approach to this disease. In New York the same thing is happening, with a cross-departmental approach to solving the issue of Lyme disease. If all of these countries are taking roughly the same initiative and if the European Union is debating having a similar approach then surely we can force as a matter of urgency that the report be completed and the appropriate actions out of that report to be taken. I urge the Minister not to allow this to go on for long more. Tick Talk and others recognise the work being done by the Minister in this area but they point out that time is hugely important to them and ask the Minister to recognise this in the context of action being taken.

I recognise that reports are only as good as their implementation and the commitment I give the Deputy is that when the report goes to the scientific advisory committee I and the Department will base our actions, and I use the word actions, based on the scientific advice. I would be happy to meet the Deputy to discuss further these actions and implementation, once the report has been received in November.

Hospital Charges

Eamon Scanlon


70. Deputy Eamon Scanlon asked the Minister for Health his views on the campaign to abolish inpatient charges for cancer patients who do not qualify for a medical card and do not have private health insurance; and if he will make a statement on the matter. [43269/18]

I am asking this question on behalf of my colleague, Deputy Eamon Scanlon. It is to ask the Minister his views on the campaign to abolish inpatient charges for cancer patients, specifically cancer patients who do not qualify for a medical card and do not have private health insurance.

I thank Deputies Scanlon and Curran for the question. Significant progress has been made over a number of years and over the lifetime of successive Governments in dealing with cancer treatment, with significantly improving survival rates in our country. The National Cancer Strategy 2017-2026 aims to build on the progress already made, with improved cancer prevention, diagnostics, treatment and aftercare support. The Irish Cancer Society made a significant input into the drawing up of the strategy and plays a very positive role in supporting people affected by cancer, for which I thank it.

While I appreciate the sentiment behind the society's campaign on hospital charges, making exceptions to these charges on the basis of illness or treatment risks creating inequity within the system.

The statutory co-payment, which is capped at a level that is not large relative to the true cost of providing hospital services, represents an important contribution towards hospitals' operating costs. While the overall charges are subject to ongoing review, we all need to be honest with each other about the significant financial implications their overall abolition would have.

In budget 2019 the Government decided to prioritise the extension of the GP visit card income thresholds, the reduction in the drug payment scheme monthly threshold and the reduction in the prescription charges for those aged over 70 with a medical card. The Sláintecare implementation strategy commits to considering all existing charges in the context of the annual budgetary process and this will allow for priorities to be determined in reviewing and considering the scope for a reduction in charges.

I would rather see a situation where we reduce charges overall than a situation whereby we pick a reduction based on disease or condition. While a strong case can be made, as the Irish Cancer Society did, people with chronic obstructive pulmonary disease, COPD, cystic fibrosis and other conditions could equally make the case. We are on a road of reform with Sláintecare that is committed to reducing further inpatient charges and the fact the current charges are capped at a maximum of €800 in any period of 12 months is the roadmap to use. The Department will review eligibility and charges as part of our Sláintecare implementation and I will certainly consider it in this context.

I thank the Minister. Quite obviously a diagnosis of cancer for anyone is a very concerning issue. This particular campaign is quite specific in who it addresses. It addresses people who do not qualify for a medical card and do not have private health insurance. If people are relatively affluent they may well have private health insurance. It indicates that people are on a fairly restricted budget. Many cancer treatments are over a protracted period of time. Generally people are either in work less or not at all. They have a reduction in income and at the very time they have a reduction in income they have additional treatment charges. While the Minister rightly states he is trying to reduce charges and that the maximum inpatient charge in a year is €800, this is a significant amount of money at a time when people are experiencing a reduction in income. It is for a specific cohort of people, not those who are particularly affluent but those who are squeezed, who pay for everything and who get very little in return. The concern is that the charge the Minister speaks about as being a reduced charge is a really punitive charge for this group of people.

I accept there were a number of issues on which the Irish Cancer Society campaigned in advance of the budget. I recognise it welcomed some of the measures in the budget. It welcomed the fact we heard their call regarding a rise in the price of cigarettes, which was supported throughout the House. It also welcomed the extension of the HPV vaccine to boys and the reduction in medication costs, although it and I want to do more in this regard. I accept it also highlighted very much, as the Deputy has done very eloquently, the impact, albeit capped, that large costs can have on somebody at a very vulnerable moment in his or her life. We know the burdens of cancer, not just the medical and psychological burdens but also the financial burden. I recognise this. What I am trying to say is that in addressing this burden I want to try to do so in a way that is not disease specific but recognises the fact there has to be an equality of access, and there are many people with a wide range of disease and illness who find themselves going to our hospitals quite a lot. I would like to use the work we are doing through the Sláintecare implementation plan to look at how best we reduce those charges. I will certainly look at the Irish Cancer Society's submission in this context.

I thank the Minister for his response. I will not reiterate all of the points. There is the specific concern with regard to some cancers about the longevity of the treatment and that it is over a protracted period of time. I indicated quite clearly that for some people it means taking time out of work. They are on reduced or no income depending on what they have. They probably do not have critical illness insurance or private health insurance. At the very same time, they have medical expenses. It is not just the direct medical expenses but the incidentals, including, as I stated earlier, car parking charges. They mount up for those attending and who require ongoing regular treatment over an extended period. If they have private health insurance, are affluent or in work it is different but there is a cohort of people who require fairly intensive treatment over an extensive period and their ability to meet these charges is quite restricted.

Deputy Curran and I are not going to disagree on this. There is no doubt there are extra costs when somebody has an illness, particularly one that can last a sustained period of time, such as cancer. It is not just a cost to the person but also to their entire family. We all have to work to try to reduce that cost burden. I am committed to doing that. The Deputy referenced the issue of car parking charges and I heard him speak about these earlier.

The Deputy is correct to highlight this. As he is aware, I have asked for a review of all car-parking charges and hope to be in a position to update the House in that regard very shortly.

General Practitioner Services

Bríd Smith


71. Deputy Bríd Smith asked the Minister for Health his plans to improve general practitioner coverage nationally in view of the strain that the proposed legislation on abortion rights will put on general practitioners and access for women nationally. [43626/18]

On this historic day, most Deputies are very happy that the House voted by a margin of 10:1 to progress the Health (Regulation of Termination of Pregnancy) Bill. My question concerns the level of general practitioner, GP, care available. There is a crisis in GP care. How will it be affected when women want to access termination services in January? What plans does the Minister have to improve the level of GP care?

I thank the Deputy for her question. As she is aware, preparations for the implementation of the termination of pregnancy services are at an advanced stage. I welcome that the House passed the Bill through Second Stage, which is crucial, as is ensuring that the services will be ready to be put into operation. As the Deputy is aware, it is envisaged that most terminations up to nine weeks of pregnancy will take place in the community setting. Several medical practitioners have expressed an interest in providing termination of pregnancy services. The Deputy heard the evidence of representatives of the Irish College of General Practitioners in that regard to the Joint Committee on the Eighth Amendment of the Constitution. Officials in my Department and the HSE are drafting contractual proposals for the provision of these services. It is intended that the contract will be available to qualified medical practitioners who wish to provide the services as well as organisations that provide women’s health services. It is vital that we have safe, accessible, woman-centred termination of pregnancy services in place by January 2019 and the Government has provided additional resources in the recent budget to ensure that will be done.

More generally, engagement is due to recommence tomorrow with GP representatives on a package of measures including service improvements and reform to the general medical services, GMS, contract. I recognise that GPs, like very many people, suffered additional burdens and costs during the financial recession. I wish to move to a situation where their careers and operation in the community are far more sustainable. I have reached agreement with the Minister for Public Expenditure and Reform, Deputy Donohoe, on a multi-annual investment programme in general practice and I am delighted that representatives of the IMO will meet officials of my Department to try to make progress on this. We have set a deadline of the end of the year for progress. That relates to the Deputy's broader point on the sustainability of general practice as we ask GPs to take on new services.

Specifically on the provision of termination services, my Department and the HSE are drafting contractual proposals in that regard. We will resource general practice to provide the services. As I consistently stated during the referendum campaign, it is important to note that this will not in any way overwhelm the Irish health service. That possibility is not often raised in the context of other conditions or GP attendances.

I am sure the Minister has a better handle on the numbers etc. than I do, but they are quite alarming. The average number of doctors per 1,000 patients is 3.3 in the OECD but in Ireland it is 2.7. Unless those figures rapidly change, that will require action, particularly in areas where GPs see more patients than is the case in other areas. North inner city Dublin has the highest level of patients to doctors in the country at 1,218 patients per GP, while next in line is a rural area, Laois-Offaly, where there are 1,176 patients per GP. Combined with the imposition of a three-day waiting period and the possibility of doctors opting out of or conscientiously objecting to the provision of these services, there could be flashpoints in which there will be real problems accessing services to terminate pregnancies.

We must also very seriously consider the level of general GP care across the country. That needs to be addressed. An alarming 31% of current GPs are due to retire from the profession in the next five years. How will we replace that level of care in a timely fashion?

We are providing for extra GP training places. It is not good enough just to train more GPs; we must work to ensure that general practice is and will be a sustainable career for those studying to become a GP. That is why we are providing a programme of investment as well as extra training places. Talks on that general programme of investment are to take place tomorrow with the IMO, which has asked for the matter to be resolved before the end of the year and that a multi-annual programme of investment for general practice be implemented. I accept that general practice took a hit in that during the economic recession under successive Governments.

Beyond that, in the budget we provided specific resources relating to the termination of pregnancy, as the Deputy is aware. As she is also aware, I have appointed Dr. Peter Boylan to work with the HSE to ensure these services are ready. An issue raised with me by GPs and the medical colleges is the provision of a medically operated out-of-hours telephone service as an extra support for women and doctors and I have directed the HSE to have that service in place by January.

Members will have the chance to table amendments to the legislation. The three-day waiting period and two doctor visits into which women will be forced will cause genuine problems, particularly in flashpoint areas such as parts of rural Ireland and poorer areas of inner city Dublin with a far higher ratio of patients to GPs than the rest of the country.

An interesting article in The Irish Times today addressed the question of conscientious objection. The writer pointed out that doctors may object to providing the services not because they have a problem with dealing with terminations but because they have a problem with a work payment situation. Under FEMPI, doctors' income was cut by 25% and that has not been reversed. Numerous problems must be dealt with but my fear is that having repealed the eighth and gained access to termination the women of this country will encounter real problems accessing GPs to deliver that service, particularly in more vulnerable areas such as isolated parts of rural Ireland or poorer parts of inner city Dublin.

I have addressed the issues of FEMPI cuts and investment in general practice by outlining the process we intend to undertake and on which there will be further engagement with the IMO tomorrow.

I will save my comments on how the service will operate in terms of the three-day period for Committee Stage of the Bill, when there will be an opportunity to engage on such issues. My basic premise is to do what I stated I would do during the referendum. We asked the Irish to vote "Yes" and we published a draft general scheme which was debated the length and breadth of the country. Regardless of my personal views, I have a responsibility and a duty to move ahead with legislation that is very closely aligned from a policy perspective to what we stated during the referendum campaign we would do.

On GP numbers, the Deputy and I are largely on the same page on the issue of termination. Those on the other side of the debate often raise concerns that not enough GPs will be willing to provide this service or they will be overwhelmed by the number of women seeking to avail of terminations or awful phrases such as that. The evidence does not supports such views. Many doctors put their names forward during the referendum campaign as being willing to provide such services. The Irish College of General Practitioners indicated its views in that regard to the joint committee and I am confident that we can make progress on the matter.

National Treatment Purchase Fund

John Curran


72. Deputy John Curran asked the Minister for Health the additional procedures to be carried out in 2019 under the National Treatment Purchase Fund, NTPF, resulting from the increase in funding from €55 million in 2018 to €75 million in 2019; and if he will make a statement on the matter. [43168/18]

An increase in funding to €75 million for the National Treatment Purchase Fund was announced in budget 2019. What additional procedures and treatments will be provided in 2019 as a result of that additional funding?

I thank the Deputy for his important question. Reducing waiting time for patients for hospital operations and procedures remains a key priority. As the Deputy correctly stated, in budget 2019 we further increased investment in this area, with funding to the National Treatment Purchase Fund to increase from €55 million in 2018 to €75 million in 2019, an overall increase of 150 % since the Government came into office and entered into the confidence and supply agreement.

In 2019, the NTPF plans to deliver 25,000 inpatient day case treatments, an increase of 5,000 from the 20,000 procedures committed to in the waiting list action plan this year. In addition, provision of 5,000 gastrointestinal scopes will be arranged by the NTPF, an increase of 1,000 from its target for this year. Furthermore, 40,000 first outpatient appointments will be arranged. This is a very important point. As has been acknowledged by Fianna Fáil, we have made significant progress. There has been a very significant reduction in the inpatient day case list, from approximately 86,000 people waiting for hospital operations or procedures at its peak to the low 70,000s. The number waiting is projected to continue to drop month on month. We know the investment is making a difference in that area. We now need to target outpatient lists, which is why I will be putting a particular focus on those 40,000 first outpatient appointments in terms of the resourcing of the NTPF.

There have been ongoing improvements in the number of patients waiting for inpatient and day case procedures this year, with the number now at 72,700, down from a peak of 86,100. That is a 16% reduction and the number awaiting treatment will continue to fall. The number of patients waiting for over nine months has reduced from over 28,000 to under 19,000 in the same period, a 32% reduction. It is expected that through the combination of HSE and NTPF activity this trend will continue. It is projected that the overall number of patients on the inpatient day case waiting list will reduce to approximately 70,000 by the end of this year and to under 59,000 by the end of 2019.

NTPF activity next year will cover approximately 50 high to medium-volume procedures and will be through a combination of treating patients in outsourced facilities and public in-sourced facilities. I will publish a waiting list plan with the NTPF detailing that but about 50 high to medium-volume procedures will be targeted in 2019.

I thank the Minister for the reply. In the opening part of the reply, he mentioned that spending has gone up by 150% from what it was a number of years ago. Yes, it has because it came off the back of a very low base. I am glad to see the Minister acknowledge and identify the procedures that are being carried out.

I do not want to play politics with it but I want to be very serious. A decade ago, we were spending more than €75 million on the NTPF at a time when the total health budget was considerably less than the €17 billion it is today. The Minister quite rightly identified the various procedures, including 40,000 people on the outpatient list who can be targeted this year. I am concerned that he is not ambitious enough in respect of the NTPF. Over the past number of years, these lists across outpatients and so forth have grown very significantly. There is an opportunity to be more ambitious. I would have hoped that the budget for the NTPF this year would have been more like €100 million rather than €75 million and that we would have a really ambitious programme. I say that on the day when the Taoiseach stood where the Minister now stands and said that if anybody had any suggestions for the extra €1 billion in health, they should tell him. I am suggesting that a small portion of it could be directed at the NTPF with very specific targets.

I do not want to play politics with this either because I accept Deputy Curran's bona fides on this. I would just make the point that the confidence and supply agreement did commit to €15 million so in fairness to Deputy Curran's party and the Government, I think we are doing more than we said we would do together through confidence and supply. I would make the point, which the Deputy would recognise, that the funding for the NTPF is not the totality of funding on waiting list initiatives. In fact, it is still very much at the margins. As the Deputy rightly says, the HSE has a budget of over €17 billion. I would make the point, particularly when Deputy O'Reilly is here, that it is not all for outsourcing either. An awful lot of it can and should be used on in-sourcing. I have met all the hospital groups in recent days and weeks and have asked them to put forward their proposals for in-sourcing. For example, we have opened a cataract theatre in Nenagh as a result of that. I must also make the point that outpatient waiting lists were not published until a few years so people who say the lists are at a record high are not comparing like with like. The previous figures were never published.

We have seen a lot of progress, for example, with regard to cataracts. At the end of July 2017, there were 10,024 people on the waiting list. This figure has dropped to 6,626 at the end of September so we have an awful lot more to do with regard to this. I am always happy to allocate more funding in this regard. We will work our way through this in the service plan.

I know some Members of this House have an ideological viewpoint that is opposed to the NTPF. I look at it from a pragmatic point of view. It delivers a service for people who are currently waiting on lists. I think the Minister should consider being more ambitious in terms of what is available and that we need to consider extending the services offered under it. For example, we could look at the role it could play in terms of providing services for children. By that, I mean children who require diagnosis, be it in terms of occupational therapy or speech and language therapy and some initial treatments. Some of those waiting lists for young children are unacceptably long. I believe a targeted approach from the NTPF could have a role to play here and should be examined.

Like Deputy Curran, I do not approach this from an ideological viewpoint. I very much see the NTPF as an agency that should be seen as an access fund and a way of making sure we can have ring-fenced budgets to ensure our patients can get more timely access to treatment, be it inpatient or outpatient. I am ambitious when it comes to seeing the NTPF extend its remit to outpatients. We need to do this in a careful way and that we make sure that if it is outsourced, they look after the entire episode of care so that someone is not just seen on an outpatient list and then referred back to a public hospital list for an inpatient procedure.

I agree with the Deputy with regard to the assessment of needs issue. As the Deputy is aware, we have funding in budget 2019 that the Minister of State, Deputy Finian McGrath, will reflect in the service plan for 100 additional therapist posts. I certainly do not rule out looking at other ways of using the NTPF if it can be helpful.

Orthodontic Services Waiting Lists

James Browne


73. Deputy James Browne asked the Minister for Health the waiting time targets in place for children needing orthodontic treatment in County Wexford and the south east and if he will make a statement on the matter. [43559/18]

My question concerns the waiting time targets in place for children needing orthodontic treatment in County Wexford and the south east.

The HSE provides orthodontic treatment to children who have the greatest level of need and who have been assessed and referred for treatment before their 16th birthday. The HSE aims to commence treatment for the majority of patients within two years of assessment with patients with greatest clinical need being prioritised for treatment.

I am aware that there are particular challenges at present in the south east as waiting times have been affected by difficulties in filling the orthodontist post for County Wexford. The vacancy has been re-advertised with a closing date of 14 November 2018. Subject to the outcome of this process, the HSE is hopeful that the post can be filled early in 2019.

In the meantime, there is currently a one-day-a week assessment and review service in Enniscorthy with a treatment service being offered in Waterford and Kilkenny locations. I appreciate that it is far from ideal but it ensures that patients from County Wexford are able to access services pending the filling of the vacant position. In order to help address long waiting times, in 2016, the HSE procured orthodontic services in primary care from a number of private service providers. I understand that 225 patients from the south east are being treated under this programme. I hope we will be successful in filling the vacant orthodontist post for County Wexford. The closing date is 14 November. Subject to a successful outcome, we will move to fill that post as quickly as possible so that it can be operational early in 2019, which should significantly improve the service for people in the south east.

At this stage, the waiting list for orthodontic treatment is simply out of control. Nationally, there are over 18,000 children on the waiting list, of which 7,500 have been waiting over two years. In the south east, 3,000 children are waiting for treatment with 1,500 waiting over two years and over 150 waiting over four years. In my county of Wexford, 700 children are in need of orthodontic treatment. Over two thirds of these children have been waiting in excess of two years. My office is inundated with phone calls, texts, emails and people calling to the office. Parents are dismayed by these waiting lists.

Waiting has an impact on mental health. Unfortunately, we live in a society where perfection is increasingly becoming an issue. Having to wait longer during their teenage years is having an impact on the mental health of children who desperately need orthodontic treatment.

I acknowledge Deputy Browne's point and I will raise it with the HSE in the context of the preparation of the service plan for 2019 and the NTPF in the context of its work on waiting list initiatives. It is fair to say there is a particular issue in the south east, particularly in the Deputy's county with that vacant orthodontist post. In fairness, the HSE has tried to fill it but it was not successful. It has now re-advertised the post and hopes to fill it. The closing date is 14 November. I will certainly keep in close contact with the HSE with regard to making sure that if a suitable candidate is identified on 14 November, everything is put in place to ensure that person is operational and in post as quickly as possible. I take the broader point made by the Deputy and will raise it with the HSE in the context of the service plan.

I hope the Minister applies as much pressure as possible to ensure that this specialist is put in place. Children who are assessed towards the end of primary school are coming up to the leaving certificate still not having received the treatment they desperately need. It is undermining their self-confidence and in some cases, their mental health. I ask the Minister to ensure that this is addressed as quickly as possible.

I will do so. I will keep in contact with Deputy Browne in respect of this matter and will ask that the HSE comes back to him after 14 November with regard to how successful it has been in filling that vacant post.

Hospital Waiting Lists

Marc MacSharry


74. Deputy Marc MacSharry asked the Minister for Health the action which will be taken to address the long outpatient waiting times in Sligo University Hospital in which 1,136 persons are waiting more than 18 months for an appointment. [43620/18]

What action will be taken to address the long outpatient waiting times in Sligo University Hospital where 1,136 persons are waiting more than 18 months for an appointment?

I thank Deputy MacSharry for raising this matter. As he is aware, in budget 2019, we have prioritised improving access and reducing waiting times for patients with funding to the NTPF increasing from €55 million in 2018 to €75 million in 2019. I am pleased to say this increase in funding will allow us to target 40,000 outpatient appointments.

The Deputy has raised with me before the importance of using the NTPF for inpatient day cases where we have seen progress. We are also now asking it to play a role for outpatients too. To date in 2018, the NTPF has approved almost 12,700 additional first-time outpatient appointments and this will increase to 40,000 appointments next year. I recently met with the CEOs of all hospital groups to discuss improving access for patients and requested that they work with the NTPF and HSE to develop new proposals to address the number of long waiters on outpatient lists in 2019.

Sligo University Hospital, through engagement with the NTPF, will be running an additional ear, nose and throat, ENT, clinic every week from November to help reduce those waiting for their first appointment. This is good news for people in the Deputy's county. Sligo University Hospital specifically, and Saolta Hospital Group, have demonstrated a clear commitment to reducing the number of outpatients waiting to be seen. Since 2017 additional outpatient clinics have been held for gynaecology, general medicine and neurology to increase the number of patients seen and reduce long waiting times. Sligo has also embraced several other approaches, including the use of virtual clinics in the orthopaedic department; a restructuring of the acute pain clinic to allow for referrals to be triaged and treated by a multidisciplinary specialist team; and the development of an ophthalmology service. The Sligo eye care model which people talk so much about is something that I would like to see rolled out as part of our Sláintecare plans and our HSE service plan in 2019. We will have funding for additional outpatient and hospital appointments in 2019. I will work with the Saolta group to consider more initiatives for Sligo. I am very pleased that from next month we will have an additional ENT clinic every week in Sligo funded through the NTPF.

It is good news that there will be more money available in 2019 but in terms of the here and now there are 1,136 people waiting. When the Minister took office in May 2016 there were 65 in the same category. That is a seventeenfold increase in that time. Nationally, the Minister is aware that the outpatient lists have hit another record high of 515,547 with almost 150,000 of those patients waiting over a year. While I am pleased that the NTPF is finally to be used for outpatients I have a concern being from the north west, the marginalised part of the country in all disciplines and all budgetary Votes, about what proportion of the 40,000 places will be reserved for the Saolta group and, in particular, Sligo University Hospital and Letterkenny. It is not just my county because as I am sure the Minister is well aware Sligo University Hospital services five counties or at least part thereof. There were 20 people waiting more than a year for an orthopaedic appointment in May 2016 but now there are 475. I am glad that the Minister mentioned another ENT clinic. The waiting list for that was 51 in May 2016 but now it is 764. I will let the Minister respond to that before I conclude.

When I read the outpatient waiting list figures for the Deputy's hospital – if I may call it that, although I accept it is very much a regional hospital that serves several counties – and consider the specialties, the ENT specialty is indeed accounting for the largest proportion of people waiting for an outpatient appointment in Sligo University Hospital. Therefore, it is appropriate that the first area we target with NTPF funding starting next month is additional ENT clinics. I particularly thank the hospital, one which as the Deputy knows is limited in physical space, although perhaps that is for another conversation, for arranging to run evening clinics to ensure this can be facilitated. I also want to thank it for informing me that it is going to review the space now used by the ENT which has longest waiting times. There is the potential to modify existing rooms with the fit-out of equipment to create three procedure rooms and to soundproof a third audiology room. The hospital would then be able to see an additional 384 patients annually. I very much take the Deputy's point in wanting to ensure that the Saolta group in that part of the country gets its fair share of resources. My message to the Saolta group, and I have delivered it in person, is to come forward with as many proposals as possible. I visited Sligo University Hospital where I delivered that message. Any proposals that can help drive down waiting lists will be favourably received by the Department of Health.

I would like to see the Minister positively discriminate against the north west of the country in terms of the 40,000 places that will be funded through the NTPF. It always worries me when the Minister puts the onus on the hospital to come up with a plan. We are driving the bus up here, at least we should be. People have been waiting for a long time not just for ENT but for the full range of procedures, although the biggest number is for ENT, and that initiative is appropriate. If the hospital is showing such a good initiative for ENT why not go the extra mile and fund additional clinics across the spectrum with the help of the NTPF?

As I outlined to Deputy MacSharry and his colleague, Deputy Curran, with the additional funding for the NTPF in 2019, we will be able to see a significant increase in the number of outpatient appointments. The Deputy's party has acknowledged the progress made in inpatient day cases where there has been a very significant reduction of 16% from the peak in the number of people waiting for a hospital operation or appointment. We now need to apply that same level of scrutiny to our outpatient lists. I am very pleased that we are in a position, through the NTPF, to fund the additional ENT clinic on a weekly basis from next month in Sligo. I accept there is more to be done and that it is the Deputy’s job to make the case for his region. I will have to approach this with fairness based on clinical need. We are driving the bus but there are many people employed within the health service to come up with ideas and put forward waiting list plans for consideration in respect of funding and I look forward to receiving them.

Hospital Waiting Lists

John Lahart


75. Deputy John Lahart asked the Minister for Health the action he will take to address the long outpatient waiting times in Tallaght University Hospital in which 6,269 persons are waiting more than 18 months for an appointment [43577/18]

What action will the Minister take to address the long outpatient waiting times in Tallaght University Hospital, where over 6,000 have been waiting more than 18 months for an appointment?

I thank Deputy Lahart for this question. As I already said to his colleagues, Deputies MacSharry and Curran, reducing the outpatient waiting list and reducing waiting times in general is a priority and must remain a priority for Government, for all of us in this House and for the health service. That is why we have in working with the Deputy's party increased the level of funding for the NTPF from €55 million in 2018 to €75 million in 2019, of which there will be ringfenced funding of probably €6 million, although I am finalising that figure for outpatient activity.

To date in 2018, the NTPF has approved almost 12,700 additional first-time outpatient appointments and this is projected to increase to 40,000 appointments next year. I recently met with the chief executive officers, CEOs, of all hospital groups and the CEO of Tallaght University Hospital to invite them to bring forward new and innovative proposals to address the number of long waiters on outpatient lists in 2019. We now have the funding for this and I want to receive as many ideas as possible.

To date this year the NTPF has approved proposals to treat more than 2,200 outpatients across a range of specialties at Tallaght University Hospital, through the provision of an additional 177 outpatient clinics.

Tallaght University Hospital advises it has a waiting list decision support system in place which plans and forecasts outpatient demand, allowing the hospital to ensure planned improvements are delivered. Tallaght University Hospital has also recently recruited new consultants in orthopaedics, neurology, and ENT, additional advanced nurse practitioners in rheumatology, and has additional physio-led clinics in specialties such as gynaecology. This is very important as an innovative approach. I thank Tallaght University Hospital for the work it has done.

The longest waiting periods for outpatients are particularly in ENT, dermatology, urology, neurology, gynaecology and orthopaedics. I will consider this specifically in the context of the NTPF's outpatient plan for 2019 and I look forward to receiving proposals from the Dublin Midlands Hospital Group.

The Ceann Comhairle may have noticed that the most mentioned acronym today is NTPF. Fine Gael abolished it. In what way had Fine Gael hoped to deal with this issue, going back six or seven years? The Minister's answers this afternoon have all been peppered with the NTPF. It was a Fianna Fáil invention. Fine Gael scrapped it and did not want to countenance it in the confidence and supply agreement. The Government had to be persuaded. That is a genuine question. In what way had Fine Gael hoped to deal with the waiting lists? What was Fine Gael's and the Government's big idea?

The Minister said for the second time since I came in here this afternoon that he welcomes ideas. He is the Minister and he is elected. He comes from a party that is supposed to be full of ideas. What are his ideas?

The Deputy's supplementary question takes us in a slightly different direction but I am very happy to engage on it. I always find this point quite bizarre because if Deputy Lahart had been the Minister for Health in 2011 and had gone into the Department of Health in Hawkins House, he would have needed good luck to find money to put into any initiative because of the state Fianna Fáil left the country in. I am honoured to be the Minister for Health at a time of expansionary budgets. The Deputy should remember that health budgets had to be cut during his party's last tenure and the beginning of my party's tenure. The NTPF was wound up but it was not as if the then Minister, Senator James Reilly, had lots of options for initiatives to fund.

He was left with extraordinarily difficult decisions. I am not afraid to embrace good ideas and I believe the NTPF is a good idea. It was not necessarily run in the best way in the past. It cherry-picked patients and allowed people who had not necessarily waited the longest to be seen. Therefore it did not prioritise the longest-waiting patients. It had a self-referral system that allowed a degree of cherry-picking and it did not do nearly enough insourcing. When it came to negotiating the confidence and supply agreement, the Deputy's party only looked for €15 million for it and today I am criticised for not putting more money into it even though we are allocating €75 million.

The NTPF has a role to play and I am very happy that it is playing a role. It is important that its role is also about insourcing and not just outsourcing, and that it targets those waiting longest. The Deputy's local hospital in Tallaght is beginning to see the benefit of that investment and I hope we will see more in 2019.

The chief executive officer of Tallaght Hospital, Mr. Slevin, is very innovative when it comes to the NTPF.

He definitely is.

I know the area covers part of the Minister's constituency.

Getting back to our discussion, Fine Gael had a big idea, which was universal health insurance. It abolished the HSE and scrapped the NTPF. Universal health insurance was going to sort everything out. Then Fine Gael decided it would not work. It then decided it needed the HSE, having abolished the board. It is now going to re-establish the board. Where are the great ideas on health and innovation in health because the Minister is looking for ideas? Fine Gael had several great ideas in 2011; each and every one of which has been abandoned.

I wish to focus on the neurology figures in Tallaght Hospital. In 2016 there were 480 on the waiting list and it is now up to 1,322 - close to 1,500. These are people who may have multiple sclerosis or have suffered a stroke. Rather than figures, what does the Minister say to the close relations of such people who come to my clinics and are incredibly anxious? It must be remembered that this is a waiting list just to get the appointment; it is not for treatment. What can I say to my constituents when I go back to them?

What the Deputy can say to them is that I am very pleased that we have now hired new consultants in neurology in Tallaght. As he rightly said, many of my constituents also go to that hospital so I firmly accept the need for that.

Here is my big idea on health. My big idea was not to be the Minister who decided to come up with a big bright plan that would last for my tenure, but instead to work with people on all sides of this House to develop the Sláintecare plan. Fianna Fáil's big idea was to set up the HSE, which clearly did not work. The next big idea was to leave Mary Harney in the Department of Health and Children for years and not have Fianna Fáil Ministers touch it. We had big ideas; lots of Ministers had big ideas.

What we actually need is a cross-party plan on health that will outlast my tenure in the Department of Health. If the Deputy is the next Minister for Health, it might also outlast his tenure. We have plan, called Sláintecare that every party in this House has bought into. I believe that is the kind of bipartisan approach to healthcare policy that people want to see.

Written Answers are published on the Oireachtas website.