Dáil Éireann - Volume 525 - 07 November, 2000

Priority Questions. - Hospital Waiting Lists.

104. Mr. G. Mitchell asked the Minister for Health and Children the reasons for the long waiting lists in public hospitals. [24518/00]

Mr. Martin: At the outset, it is important to define clearly what is meant by a waiting list. A waiting list comprises all persons who, following referral to a hospital consultant, have been listed by the consultant for treatment as a public in-patient and who must wait until the necessary hospital facilities are available for such treatment. The waiting list should comprise only those who [242] could, if the facilities were available, be treated immediately.

Waiting lists must be seen in context. As at 30 June 2000, there were 31,851 persons on hospital in-patient waiting lists. This figure has to be viewed in the context of the overall activity of more than 750,000 procedures carried out in our hospitals annually. Waiting lists are not uniform across all specialities and vary between hospitals and geographical areas. The most acute waiting lists tend to exist in high volume specialities such as ENT and ophthalmology, or in specialities where there is demand for specialised treatments such as cardiac artery bypass grafts and hip replacements. These latter procedures often reflect technological progress in treatment.

Waiting lists are a feature of many health systems across the world, as identified in the report of the review group on the waiting list initiative, which also identified all the factors that lead to the creation of waiting lists. The report made a series of recommendations to deal with them. Health systems throughout the developed world are experiencing similar difficulties in catering for all the demands that arise in some specialities.

The waiting list initiative was introduced in June 1993 and was the subject of a comprehensive review in 1998. The report of the review group contained a comprehensive set of recommendations. As of 30 June 2000, the overall numbers on waiting lists fell by 5,004 which is a reduction of 13.58% on the end of the December 1999 figure.

It is my intention to pursue continual reductions in waiting lists and waiting times for hospital treatment. In this context, following a series of discussions with the chief executive officers of the health boards earlier this year, I announced a £10 million initiative aimed at maximising available capacity in the system to enable additional waiting list procedures to be performed before the end of the year. This brings the dedicated funding to waiting list procedures to £34 million this year. These short-term measures are being taken in tandem with longer term measures associated with the £2 billion investment under the national development plan, the ongoing implementation of the recommendations of the expert review group on the waiting list initiative, the national bed capacity review and the winter initiative, which I recently announced. In essence, all of these issues deal with the fundamental reason behind the build-up of waiting lists, which is the physical capacity within the acute hospital services, primary care and services to the elderly.

Mr. G. Mitchell: Is the Minster aware that there is a waiting list to get on a waiting list to see a consultant? Is he aware that a recent letter to an Irish newspaper reported that a 91 year old man lay on a trolley in a Dublin hospital for three days? Will he confirm that in the case of neurosurgery, neurology, vascular surgery and gastroenterology, the waiting lists have increased? An [243] analysis of the so-called reduction in the waiting lists in one hospital showed that 87 patients had their surgery done elsewhere, 330 were removed from the list because they had received two letters from the hospital which were not answered within four weeks, 30 had other medical problems with preventive surgery, 17 were finance related, 12 needed back-up or intensive care and could not proceed, 64 had to see the consultant again because they had been so long on the list and 30 had died. Is this the way the waiting list is reduced by 5,004? It is more like the work of a three card trick merchant than a Minister for Health.

Mr. Martin: Leaving aside personal comments, validation processes are as important as any other factors in terms of determining who is on a list. I am sure all Members want an accurate picture of the numbers on the list at any given time. We have increased capacity within the system. It is a pity that when Deputy Mitchell held high office his Government did not maintain a consistent allocation towards the waiting list initiative. It is also a pity that there was a reduction in the funding for the initiative during the previous Government's last year in office.

Capacity is the issue here. Ultimately, we will comprehensively deal with the waiting list initiative only if we increase capacity at both ends of the spectrum, within the primary care side, especially more innovative projects at A&E level – we recently sanctioned one in St. James's Hospital and other units throughout the country – and, more importantly, with the development of services to the elderly, which relate to assessment, rehabilitative units, more long-term residential units and so on. That is the long-term comprehensive approach to dealing with the waiting list initiative. Additional human resources are also required.

There has been an increased number of procedures arising out of the additional funding we have made available. There has also been some reductions through some hospitals, not all, validating their lists. However, validation can work both ways. In some hospitals it can lead to an increase in the numbers on the list.

Mr. G. Mitchell: Will the Minister confirm that, according to his statistics, the waiting time for some heart operations is still four to five years? Given that there are more than 31,000 on the so-called reduced lists and that people are waiting to get on the lists, does he agree that what we have is a form of medical apartheid in that if one can sign a cheque one does not have any pain but poor people can wait on the public waiting list, sometimes in agony, with appointments being cancelled on a weekly and monthly basis while nobody in the Department cares, except at a political level?

[244] Mr. Martin: It is unfair to throw that at the Department. It is a function of this House—

Mr. G. Mitchell: I am accusing the Minister.

Mr. Martin: It is a function of a system presided over by successive Administrations. There is an inequity at the heart of access to Irish hospital services. It is in the form of private versus public care. The Deputy is aware of that. He has no right to lecture me about what we all know to be fundamentally a two tier structure.

Mr. G. Mitchell: The Minister is a member of a party that has been in Government for ten and a half years since 1987. Significant improvements could have been made in that time.

Mr. Martin: Funding has been allocated for public patients which will dramatically improve capacity in the acute hospital services. That involves the review of bed capacity which is currently being undertaken. This is the first such review to take place in many years.

Mr. Ring: People are dying. We want action, not more reports.

Mr. G. Mitchell: Fianna Fáil has been in Government for ten and a half out of the past 13 years.

Mr. Martin: It also involves additional funding which is being provided under the national development plan for step-down facilities, assessment and rehabilitative procedures. Design teams are in place throughout the country.