Wednesday, 25 February 2015
Dáil Éireann Debate
[Deputy Charlie McConalogue: ] Funding has not been provided for follow-up treatment and their files have been recalled to Letterkenny General Hospital to be added to its waiting list. Will funding be provided for them to continue their treatment with the consultant to whom they were initially referred?
Deputy Leo Varadkar: I understand that the Deputy's previous parliamentary question relates to the number of patients outsourced by Letterkenny General Hospital under the 2013 outpatients initiative. The HSE has advised me that all patients from the 2013 waiting list initiative who have not been seen, diagnosed, treated and discharged back to their GP have all been accepted back to Letterkenny General Hospital on their appropriate waiting list. This includes the surgical pre-assessment, day surgery and inpatient surgical waiting lists. These patients will be treated within the hospital's service and budget for 2015. For some outsourced patients, the treating consultant required further review to either verify their clinical requirements or perform further diagnostic tests. Patients requiring review were reinstated on the public waiting list to have them scheduled for treatment in chronological order. All paediatric patients concerned have already received treatment.
Improving waiting lists for inpatient and day case treatment is a key priority for me and for the Government. The HSE has already put in place specific measures to address waiting lists more efficiently in collaboration with the acute hospitals. These include observation of the national waiting list protocol as approved in 2014, adherence to the relevant HSE national clinical programme guidelines and prioritising day of surgery admission where clinically appropriate. My Department is working with the HSE to put in place a plan to eliminate very long waits by the end of the year. This will involve both operational improvements and better waiting list management.
Deputy Charlie McConalogue: I am very disappointed with the Minister's response because he has not indicated that follow-up funding will be provided for these patients to continue their treatment with the consultant who has already seen them in a private capacity.
Under the 2013 outpatient waiting list initiative, which was a previous initiative by the Government to try to address the long waiting lists, more than 3,000 patients were referred out of Letterkenny General Hospital for private consultant appointments. Of those 3,000, approximately half were discharged back to their general practitioner. There are 1,500 others, and I listed them in the question, who need surgery, diagnostics or follow-up patient reviews and for whom Letterkenny General Hospital and the HSE were expecting to be able to provide follow-on funding to allow them continue their care with the consultant who had already seen them. That follow-on funding has not been provided and those 1,500 patients are now being put back on waiting lists in Letterkenny General Hospital, but those waiting lists have got longer in recent months because of the accident and emergency department situation.
One measure the Minister could propose to help address the waiting list problem in this hospital immediately would be to provide the follow-up funding for these patients to continue their care with the consultant who has already seen them, is aware of their case and has diagnosed the follow-on treatment or diagnostics required. Unfortunately, the Minister seems not to be doing that. I would point out to the Minister that of any hospital in the country, Letterkenny General Hospital has the largest number of patients waiting more than two years to see an outpatient consultant, yet the Minister is putting these patients back on these hospital waiting lists by not providing the funding for them to continue their care. I urge the Minister to take action today to provide that funding.
Deputy Leo Varadkar: I may have misspoken in my previous reply. Patients requiring review were reinstated on the public waiting list to have them scheduled in chronological order. All paediatric patients concerned have received their treatment.
What happened is that about 2,700 patients were outsourced, in effect. They were sent for private treatment. Many were discharged back to their GP. Others required further follow-up and were put back on the public waiting list into the position they would have been in. They were not disadvantaged in any way by having their case outsourced. It is not a satisfactory situation that if somebody is outsourced and sent for private treatment, they should stay in that until their treatment is completed. That did not happen in this case. They were sent out privately for their outpatient and then put back on the public waiting list, although they were not disadvantaged in any way. They did not lose their position on the waiting list.
Regarding the Deputy's question on follow-up funding, I do not have it. If I did have it, I would provide it but at this stage I do not have it. I can say, however, that nobody has been disadvantaged by the fact that their cases were outsourced or sent privately for treatment. Anybody who has gone back on the public waiting list has gone back on in the position, in chronological order, they would have been in had they not been sent privately.
Deputy Charlie McConalogue: I agree with the Minister that it is entirely unsatisfactory. However, unlike him, I am not the Minister for Health and if the Minister believes it is unsatisfactory, it behoves him to do something to address it. He indicated to me that these patients are not disadvantaged in any way. That is not the reality. The reason these patients were referred out in the first place was because they were waiting more than one year. They were referred out at the end of 2013. Before that they were waiting at least a year, and in most cases more than a year, to see a consultant. They were referred out at the end of 2013. They then saw a consultant at the start of last year, which is more than a year ago at this stage. They are being brought back to Letterkenny General Hospital but before their treatment can be brought forward or diagnostics done, they now have to see a consultant in Letterkenny for the first time because a consultant will not decide to treat a patient without first seeing him or her. That is the position in which they find themselves. They are back to square one, as such. The difference is they know they need some follow-on treatment. That is beneficial in itself but they are back to square one in that they are waiting to see a consultant in Letterkenny General Hospital for the first time. What is required, and this can be addressed immediately, is for money to be provided and for Letterkenny General Hospital to be asked to stop requesting the files from the consultants who are treating these patients and instead provide the funding to complete their treatment. What is happening to these patients is cruel.
Deputy Leo Varadkar: I am happy to be corrected if I am incorrect but I am informed they were put back onto the point in the public waiting list they would have been on anyway, so in that sense they have not been disadvantaged. That is not to say they have been well treated, which is a different matter entirely.
If I were to provide the funding it would have to come from somewhere else, and that would mean people who are already waiting longer than these patients waiting even longer again, and that would not be fair. Funding is limited and when funding is limited, urgent cases must be treated first and then everyone else in chronological order.
Children and Family Relationships Bill 2015: Second Stage (Resumed)
Deputy Olivia Mitchell: I very much welcome the opportunity to speak on this Bill. I welcome that it is a reforming Bill updating family law and that it at last recognises in law and gives clarity and certainty to the status of family members, specifically parents with children, in the many different family formations. It gives that clarity and certainty in the context which prioritises the needs of the children.
It has been many years since the typical household was one of husband, wife and children but even when that was the norm, there were many differing arrangements for the rearing of children. Many such arrangements were informal and undocumented where, for instance, a grandparent, a spinster aunt or an uncle took over the care of a child, perhaps from a large family, or where the mother may have been ill. Many of these arrangements were very satisfactory and benign and worked in the interests of both the child and the parenting family. This was a very common practice but for many children it was not a benign arrangement. We know all too well the tragic tales of what happened to children, for instance, if they were born out of wedlock or where people in positions of power but with no legal entitlement often secretly and without any documentation sequestered children into orphanages, often for their entire lives, or sent them to work on farms or in households as virtual slaves or, worse, exported them to countries such as America, Canada, New Zealand and Australia where in many cases their fates still remain unknown.
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