Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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5. To ask the Minister for Health if he will provide the details of all public hospitals using private facilities to provide treatment for those on waiting lists; the number of cases that have been treated in this manner; the cost of same; the locations where it has taken place; if potential conflicts of interest have been identified or investigated; and if he will make a statement on the matter. [20887/15]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I seek details of all known public hospital referrals to private hospitals and so-called private addresses on the same or adjoining facilities and ask the Minister if he sees potential for abuse in such arrangements.

Leo Varadkar (Dublin West, Fine Gael)
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Reducing long waiting times for hospital treatment is a key priority for the Government. Last January, taking into account current pressures on acute hospital services, I directed the HSE to ensure maximum permissible waiting times for inpatient and day case treatment, or a first consultant-led outpatient appointment, of 18 months by mid-year and 15 months by year end. In February, shortly after the 18 month maximum waiting time was announced, the number of inpatient and day case patients requiring treatment by the end of June to achieve that requirement was 4,995. As of last Friday, 22 May, this number had reduced by about half to 2,693. The HSE, in conjunction with hospital groups, is focused on delivering treatment targets through maximising the use of existing capacity within and across hospital groups in the first instance. However, there are key limiting factors, primarily in terms of theatre nursing staff and consultant manpower in particular specialties. Consequently, it has been determined that up to 1,500 inpatient and day case procedures may need to be outsourced. A notice to tender for the provision of these services was issued on Friday, 15 May by the HSE, with a view to contracting with service providers this week. It is anticipated that the outsourcing of treatment to private facilities will commence shortly and conclude by the end of June. The HSE has advised that the number of inpatient and day case patients waiting over 18 months will have been reduced by 98% between the announcement of the maximum permissible waiting time in January and the end of June.

As regards outpatient appointments, the number at risk of breaching the 18 month maximum waiting time by the end of June has reduced by 7,773 within the past seven weeks. As well as initiatives similar to those for inpatient and day case treatment, regular intensive waiting list validation and additional clinics will be used to further reduce waiting times for outpatient appointments.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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In the context of this question, have potential conflicts of interest been identified or investigated, to the Minister's knowledge? Does he agree that a system where such referrals are allowed is open to abuse and presents a potential conflict of interest, at the very least? Given that practitioners are being paid in these instances a second time for work they are already contracted to do and handsomely paid to carry it out, does the Minister not believe a very serious scrutiny of the practice is required, if he has not already embarked on such? In case he is not aware, I refer him to a parliamentary question for witten reply which I submitted earlier this week which draws his attention to the fact - I repeat it is a fact - that this double jobbing, double pay abuse, is not confined to front-line practitioners within hospital services but applies also, apparently, to some managers and directors of services at hospitals and other settings within the HSE. Will he act to root out all such potential conflicts of interest across the health service?

Leo Varadkar (Dublin West, Fine Gael)
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I am not aware of any particular abuse that has been identified. If the Deputy wants to write to me with the details and evidence, I will certainly have the matter investigated, as is always the case. As this initiative has only started in the past couple of weeks, it is too soon, obviously, to have it audited. It is necessary. Having people waiting so long for outpatient appointments and treatment is a huge risk. Frankly, I do not think waiting periods of 15 months and 18 months are particularly ambitious targets, as the figure should be a lot less than that and closer to three or six months. However, we are doing what we can within available resources.

I accept that there is certainly potential for conflicts of interest. There is also potential for moral hazard because, when one pursues waiting list initiatives such as this, one sometimes ends up rewarding those who are not performing and those who are not keeping their waiting lists down and there are, of course, other risks. However, in this case, we really had to put patient safety and patient outcomes first, ahead of all those legitimate concerns about initiatives such as this.

One thing that is very different between what is being done and what was done by the NTPF is that it is not a case of people self-referring. What is happening is that somebody is going through the waiting lists, validating them, finding the people who are waiting for very long periods of time and offering them treatment. Where it is possible, we are using existing public facilities, but, sometimes, that is not possible. To give one simple example, there is just not enough theatre space in Crumlin hospital to undertake the number of scoliosis operations that need to be performed on young children. As a result, a number of cases have been dealt with in Blackrock, Temple Street and Cappagh hospitals, as well as in other public and private hospitals, and more will be dealt with because that is what is required.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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My concerns have been sharpened in the recent past - not for the first time in my political experience - by actual cases that have been presented to me where people either do not have private health insurance or their plan is inadequate to cover the cost of the procedure they need and they are being told about inordinate waiting times. At the same time, however, they are being pushed into the private system, with the same consultant in the same hospital, if they furnish five figure sums - fact - and it is then a case of, "We can see you in the next two to three weeks." This puts those families in financial distress as they are not the people with ready cash to pay for it. They are already struggling in life and this is a hugely important moment, a challenge to either the man or the woman, in the case about which I speak, and his or her family. This is an absolute outrage and it has fed an ever-growing view in society that there is an abuse involved, whereby waiting lists are being created to put further pressure on those who are waiting to drive them towards "pay up and pay out" to line the pockets of those in this mode in front-line practice.

They bring only shame on their profession in my view.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Sorry, this is Question Time. Thank you.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is time the Minister and the Department faced it head on.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Again, I must stress that the more time we spend on priority questions, the less time there is for the backbenchers to get their questions reached. Will Members adhere to the times allocated?

Leo Varadkar (Dublin West, Fine Gael)
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I do not believe people are deliberately creating waiting lists to pressurise people into paying out of pocket or to take up health insurance. Health insurance does not cover pre-existing conditions, so it would not cover it anyway in such cases. Quite frankly, waiting lists sometimes are badly managed. One has to drill down into them to really understand them. When I looked at some recently, I noted when it came to surgical procedures and day cases, people being seen within three months were being seen quicker. So, there were more people being seen quicker but then at the tail-end, there were people being put on the long finger for longer. That is a particular problem.

There are significant capacity constraints and it is for that reason the private sector is being employed.