Billy Kelleher (Cork North Central, Fianna Fail)
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8. To ask the Minister for Health when the upward trend in hospital waiting lists is expected to be halted; and if he will make a statement on the matter. [20781/15]

Billy Kelleher (Cork North Central, Fianna Fail)
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We have discussed this issue on many occasions. It has been raised with the Minister at the health committee at which it has been suggested it be dealt with by the National Treatment Purchase Fund, some other assistance from elsewhere or the provision of additional resources to the public system. Something has to be done. The pretence we are getting on top of waiting lists needs to stop. People are now awaiting alarming lengths of time to see a consultant on an outpatient basis.

Leo Varadkar (Dublin West, Fine Gael)
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Reducing long waiting times for hospital treatment is a key priority for the Government. To comply with the commitment which I announced in late January of a maximum permissible waiting time of 18 months by the end of June and 15 months by year end, the Health Service Executive, HSE, has put in place specific measures to address waiting lists more efficiently in collaboration with acute hospitals, the special delivery unit and the National Treatment Purchase Fund.

The effect of these measures is already evident. In early February, a total of 4,995 patients required treatment to achieve that measure. As of Friday, 22 May, this number had reduced to 2,693.

The HSE, in conjunction with hospital groups, is focused on delivering on this requirement through maximising the use of internal 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 is recognised that judicious outsourcing is also required and this is being managed through a public tendering process.

The elimination of the longest waiting periods for treatment is a key performance objective for 2015. Its achievement will allow for progressive improvement in access to treatments throughout the year.

Billy Kelleher (Cork North Central, Fianna Fail)
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I want to bring the Minister’s attention to the statistics for several regions. In Waterford, for example, 27,156 people are waiting for an outpatient appointment, of which 11,127 have been waiting 12 months or longer. That is up almost 2,000 people since January 2015 and up 8,935 in a year. That is the way the trend is going. While there may be dips from time to time, the overall trend is in one direction and it is an alarming problem.

In Cork, the figures reveal 52,000 are on outpatient waiting lists at Cork University Hospital, the Mercy and South Infirmary Victoria. Almost 13,000 people are waiting longer than 12 months for an outpatient appointment. This is not for an inpatient appointment but someone’s first contact with a consultant. It is quite alarming.

Whether the Minister has to admit defeat or otherwise, I do not mind how he does it. However, he has to do something to ensure that these people can access treatments and additional capacity is provided. If it requires using the private sector, so be it. Something must be done and quickly.

Leo Varadkar (Dublin West, Fine Gael)
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It is important to understand the figures. The higher figure will always be high. It is anyone who is waiting for an outpatient appointment for any period. That includes people who are waiting two weeks or two days. As health services expand, more consultants are appointed and more clinics are established, that number will always be high. That is the way it works.

What we do need to address is people waiting too long. The figures the Deputy used are for people waiting for over a year which is a patient safety risk. Anyone who is currently waiting over a year will have their appointment by the end of the year. We will use whatever additional finance is necessary to do that. Unfortunately, in a number of subspecialties, the relevant specialists just do not exist. We will either have to offer people appointments abroad or, in some cases, may not be able to offer them an appointment as I would so wish. It will not be financial constraint, however, that prevents that from happening.

There is a bigger picture too. Waiting lists need to be better managed. Significant numbers of people do not turn up for the appointments for which they have been waiting ages. Significant numbers of people on waiting lists are not really on them at all as they already have been seen by a different consultant or may have subsequently gone private. We also have a problem with referral rates. The numbers referred is increasing more than it should be. Often people wait for a long time to see a consultant, only to be told that they did not need to see the consultant at all or need to see a different consultant. We need to improve the quality of referrals from general practice into secondary care. The e-referral programme is a big part of that.

Billy Kelleher (Cork North Central, Fianna Fail)
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We have been talking about these particular issues for a long period and the overall challenges facing services. The Minister spoke about referrals. At the same time, GPs, general practitioners, are unnecessarily referring more people to the acute hospital system and to consultants due to lack of resourcing in primary care. GPs are effectively looking at the number of people outside their surgery doors. The Minister is one himself, so he should know how it works. Any condition that is complex or needs further analysis will often be referred on because the GP does not have the time, resources or systems and is under pressure. That is one reason there are more people going on to the waiting lists.

There is no point in us pretending but there has been a massive increase in the number of people waiting over a year. In Cork, it is almost a 600% increase. I accept the more consultants and lists one has, the bigger the headline figure will be. The one underneath that, namely people waiting a year, does not lie. That is simply because there is no capacity in the system.

Leo Varadkar (Dublin West, Fine Gael)
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It is a combination of factors. There are inappropriate referrals. Ask any speech and language therapist, any physiotherapist or any consultant and they will tell one about inappropriate referrals, namely people who should not have been sent to them in the first place. This happens, unfortunately, and needs to be better addressed. I hope the e-referral system over the next several years will allow us to tackle this well.

The Deputy is correct that there are issues in general practice. People have been referred to consultants and hospitals for 24-hour holter monitoring or minor surgical procedures, all of which could be done in general practice if it were properly funded and GPs were remunerated accordingly. That is one of the items that is now in discussion as part of the new GMS, general medical services, contract, namely better remuneration for GPs and encouraging them to do 24-hour monitoring, suturing and other minor procedures. The minor surgery pilot is already funded for this year to cover some of these.

There is a mix of issues involved. However as I said earlier, anyone who is waiting a year or more for an outpatient appointment should have that by the end of the year with the exception of a few small specialties where the specialists do not exist.