Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank the Chair. He has cut to the chase about the areas where our focus is and must be. We must prioritise the long waiters, particularly children who are waiting a long time. Let me go through some of the things we are doing that are in the Estimates. Some of the Chairman's questions fall outside the Estimates and I will come to them.

He spoke about a gentleman in need of prosthetics. If the situation is that the wait is part of that, what he needs is access to obesity services. Those services have been funded for the first time in this budget. We have a fantastic endocrinologist in Loughlinstown, near my own area. He and a colleague are leading on this. I have allocated a lot of money, millions of euro, for this year. I was told they would be able to hire a lot of people quickly. I was not entirely sure if that was true but it turned out it was and they have been hiring at an amazing pace. Ireland has been a complete outlier in terms of gastric band surgery and obesity services. We are going to start coming more in line now. We will all be aware of people travelling to, for example, Türkiye and coming back with all sorts of complications. Those patients will be treated in Ireland as services are rolled out. There are long waiting lists and there should not be. This new service is directly aimed at helping those patients.

I have asked the HSE not just to look at the waiting lists but to look at the long waiters as two groups. To its credit, the HSE is doing that and it is having an impact.

The first group is those who are waiting far too long – more than, say, 12 months. The second group is those waiting longer than the agreed Sláintecare targets of ten and 12 weeks. The HSE is working hospital by hospital and clinical group by clinical group to go through them and point out, for example, that there may be 500 patients waiting to be seen, 450 of whom have been waiting less than 12 months but there is a small group of patients who appear to be waiting for surgery for two, three or four years. In most cases, those patients have been seen by somebody else. However, in some cases, as per the example given, we have people waiting years. One of the priority areas at the moment is exactly that - finding those people who have been waiting far too long and prioritising them, not based necessarily on clinical need but the fact that they have just been waiting for far too long. We need to make sure they all get access as a priority.

The second issue is around treatment abroad. There are three schemes. There is the treatment abroad scheme, which is for services that we do not provide in Ireland. The patient or patient's family do not need to pay for such services, which are paid for by the State. The second scheme falls under the cross-border directive, where services are available in Ireland but, as the Deputy said, the wait is too long and people elect to go to another member state. In that case, the patient pays upfront and is reimbursed by the HSE. The Ombudsman’s report was welcome. It was an important piece of work. I am comforted that the Ombudsman has met the new HSE chief executive, Bernard Gloster. The Department and HSE have accepted all of the recommendations. The Ombudsman’s response was very positive in terms of the chief executive’s engagement with him on the issue of reimbursement. All legitimate reimbursement should happen very quickly. The Deputy will be aware that we have a third scheme for Northern Ireland, which is on an administrative level. It is essentially the cross-border directive for Northern Ireland. The UK came out of it, obviously, post Brexit.

On paediatric surgery, there is undoubtedly some very rare surgery for which children may need to go to London or wherever the case may be. For example, there is a charity in my constituency in Wicklow that helps children with cancer to get proton therapy, which is not provided here. There are, however, other cases where we provide the service. In the areas of scoliosis and spina bifida, for example, children are waiting too long. That is one of the areas of focus in the Estimates. We have allocated substantial moneys to reaching the agreed service level under which no child should wait more than four months unless clinically indicated. Significant progress is being made. The level of activity has increased considerably but waiting lists are still far too long. The HSE and Children’s Health Ireland did not meet the targets we set despite their best efforts, partly because of a very large number of additional referrals. I will meet Children’s Health Ireland again in the next week or two on that precise issue. I will meet clinicians and management to make sure everything that can be done is done, particularly at the moment. Once the national children’s hospital is open, the level of resources available will expand significantly. However, we cannot wait for that. In the 18 to 24 months or thereabouts before the children’s hospital opens, will Crumlin, Temple Street and Cappagh hospitals have the resources they need? Significant investment has gone into that area as well.