Speech by Minister for Health, Simon Harris TD Private Members’ Business, Dáil Éireann – Hospital Waiting lists 20 June 2018
I very much welcome the opportunity to address the House on this important issue. Reducing waiting times for patients is a key priority for me as Minister for Health and my Government colleagues.
I would like to acknowledge from the outset that waiting times for hospital procedures and appointments are often unacceptably long. Many areas in our health service currently lack sufficient capacity to meet the ever-increasing demand for services and the needs of patients.
The evidence of this can be seen not only in the waiting lists but also in my Department’s Health Service Capacity Review. Therefore, maximising the use of existing capacity in the short term and seeking to build new capacity through the National Development Plan is central to improving waiting times. I will outline the approach the Government is taking in this regard in the course of my address.
However, increasing capacity alone will not position our system to provide the services and access that our citizens demand. The Irish health service is undergoing a major transformation. The Sláintecare report, and the cross-party support that it enjoys, presents a unique opportunity to embed long-lasting reform in our health system.
So it is against this background that the Government will not be opposing this motion. It is clear to me that all of the Deputies here today have the same objective in mind – to improve access for patients. I would like to approach this debate in the spirit of solutions and I am here to listen and consider ideas from all Deputies for sustainable solution to improve access for patients. I hope that, in that spirit, it is also possible to acknowledge progress, and to accept the factual context that our health service will treat 3.3 million patients as outpatients this year and deliver 1.7 million hospital operations or procedures outside of the additional work under the NTPF.
Government Actions to Improve Waiting times
The National Treatment Purchase Fund (NTPF) is responsible for collecting and validating all waiting lists for public hospitals. The most recently published NTPF figures for the end of May confirm that just under 78,600 patients are waiting for a hospital inpatient or day case procedure.
In July 2017 the number of patients waiting for an inpatient or day case procedures stood at a high of 86,100. This represents a fall of more than 7,500 patients, or almost 9% in just 10 months. NTPF figures for the end of May this year also show that 56% of patients who are on the waiting list for an Inpatient or Day case procedure were waiting less than 6 months and 82% were waiting less than 12 months for their procedure.
This positive progress in reducing waiting times for patients waiting for a hospital procedure is the result of the focus and investment by Government in this area. In Budget 2018, €50 million was provided to the NTPF to provide treatment for public patients this year, which more than doubled its 2017 total allocation for the NTPF.
I published the Inpatient and Day Case Action Plan in April which marked a very important milestone in delivering on the Government’s objective to tackle waiting lists. The Action Plan is a joint initiative between my Department, the NTPF and the HSE with the aim of reducing the overall number of patients waiting for treatment. One of the central goals set out in the Action Plan is that by the end of 2018 the number of patients waiting for treatment will fall below 70,000, down from that historic peak of 86,100 in July 2017 and that the number of patients waiting longer than 9 months will fall by 10,000.
To the end of May the NTPF has organised treatment for almost 7,600 patients – the total number treated in 2017 through the NTPF was just over 6,600.
There are seven high volume procedures that are the focus of the Action Plan 2018, specifically cataracts, hip/knee replacements, tonsils, angiograms, cystoscopies, skin lesions and varicose veins. All patients who are waiting more than 9 months and are clinically suitable for treatment in an outsourced facility, will be offered treatment in 2018 for targeted high-volume procedures. For patients who are waiting longest for other procedures, the NTPF and HSE will work together to identify their requirements, develop treatment plans, and where possible offer treatments from within existing HSE and NTPF resources.
The impact of Storm Emma, cancellations of elective treatment and the increase of emergency procedures arising from significant Emergency Department pressures over the Winter and other factors have resulted in fewer procedures for patients on waiting lists taking place in our public hospitals. In the Action Plan the NTPF committed to provide 20,000 procedures for patients. This delivery against the plan is being actively monitored by my Department.
Through the active monitoring of the Action Plan and the close collaboration between the Department, the HSE and the NTFP, it has been agreed that the NTPF will now target an additional 2,300 procedures in 2018, to ensure the 2018 targets are met.
The NTPF will provide all the treatment for patients in both public and private hospitals. The NTPF has invited all hospital groups to develop proposals for their consideration to maximise the use of existing facilities and capacity. For example, in the UL Hospital Group, a dedicated Cataract theatre is being opened in Nenagh General Hospital and the NTPF will fund treatment for patients in this new facility in 2018.
In addition, my Department, the HSE and the NTPF recently met with representatives from the Royal Victoria Eye and Ear Hospital, in the Ireland East Group, to discuss proposals from them to use spare theatre capacity to treat children and adults on the ENT waiting list in other hospitals at weekends and over the summer period. A detailed proposal from Ireland East for priority consideration by the NTFP is expected in the coming days. These are just two examples of how my Department, the NTFP and the HSE and individual hospitals are seeking to identify opportunities to maximise the use of existing public facilities to treat patients.
While positive results have been witnessed through the work of the IPDC Action Plan, the Outpatient Waiting List remains a significant challenge to be addressed in 2018, with 511,000 waiting for an Outpatient appointment. As I said, each year, 3.3 million patients attend Hospital Outpatient clinics for appointments. I think it is important to say that just over 70% wait less than 12 months – contrary to the impression that is sometimes created – just over 60% wait less than 9 months and just under half wait less than 6 months.
However, this is not to in any way downplay the very serious situation for those waiting too long which we are determined address. In order to address the issue of growing outpatient waiting list numbers, my Department, the HSE and the NTPF are in the process of finalising an Outpatient Action Plan for 2018. This plan will support the HSE’s compliance with their National Service Plan targets, reduce the growth in the number of patients waiting for outpatient services, improve the accuracy of the waiting list, and trial a number of NTPF funded interventions, including weekend and out of hours clinics.
It is worth noting that in 2017 almost half a million (477,000) outpatients did not attend their appointment. Therefore, the validation of waiting lists is an important part of the Outpatient Action Plan and of the successful management of waiting lists and clinics.
Since the end of 2017, the HSE and individual hospitals have undertaken validation of waiting lists. To build on this momentum, this month I approved the establishment of a Central Validation Office in the National Treatment Purchase Fund in order to centralise the validation of all waiting lists across the HSE. The NTPF envisages being in a position to commence validation of patient files from September of this year.
I note and share the concern expressed in the motion about the monitoring of private practices in public hospitals. Under the Consultant Settlement Agreement, all parties acknowledge that they are committed to providing a high quality public health service and recognise that the Consultant Contract 2008 is fundamental to that provision. A central concern of myself and this Government, is the monitoring of the private practices in public hospitals and my Department and the HSE have recently agreed a robust framework at national and local level to ensure compliance.
Implementation of Sláintecare
As I outlined at the outset, the Sláintecare report presents the opportunity to reform our health system and the implementation of this report is central to the development of sustainable solutions to significantly reduce waiting times.
In the twelve months since the publication of the Sláintecare Report, the Government has taken significant steps to commence the programme of reform that Sláintecare envisaged. These include:
- A commitment to the establishment of a Sláintecare Programme Office;
- The establishment of an independent review group to consider how best to remove private practice from public hospitals;
- The completion of a public consultation on the geographical alignment of Hospital Groups and Community Healthcare Organisations, which will inform work on broader health service structural reform.
The development of an integrated waiting list solution, tailored specifically to meet the needs of our complex health system is being considered as part of this major reform programme. I fully support the view that there is a need for a more integrated approach to waiting list management at hospital group level. The NTPF, on my request, has examined the feasibility to progressing to an integrated system, and this report is being reviewed by my Department. The NTPF reviewed models in a number of jurisdictions, including in Portugal. The introduction and success of their electronic health data management system built upon an extensive reform of their health system over a lengthy period.
The National Development provides for a major increase in capacity across the health system, including the development of new dedicated ambulatory elective only hospitals in Dublin, Galway and Cork. The aim of these elective only hospitals is to both increase capacity and to provide for a better separation of scheduled and unscheduled care, in line with the Sláintecare recommendations.
To conclude, I welcome this debate and I am committed to working collaboratively with all of you to find solutions to the challenges facing our health system, in the best interest of patients, and to implement them.
Progress is being made in improving access to hospital procedures in 2018. As I have outlined, the target is for under 70,000 to be waiting for a procedure by year end and to achieve this the NTPF funding will supplement HSE activity and deliver treatment for over 22,000 patients in 2018 – in 2017 the comparative figure was 6,600.
I acknowledge that this is still too high and still too long a wait time for many patients – but it is now moving in the right direction month on month and we will build on this.
The Outpatient Waiting List remains a significant challenge to be addressed in 2018 and in future years and the publication of the Outpatient Action Plan 2018 in the coming weeks will be important in this regard.
However, to reduce waiting times in line with best international standards, we must, through the implementation of Sláintecare, fundamentally change the way we deliver healthcare in this country to allow us to provide high-quality, safe and fair healthcare for all our citizens.