Bríd Smith Questions Breast Screening Backlog and Staffing Shortages

Thanks Chair. I'd like to ask Ms O'Doherty, you said earlier on that you're using the resources to the best of your abilities and I honestly believe that but of course the problem here is the lack of the resources. But you reckon, I think you can correct me if I'm wrong, that there could be 450 cancers have been missed through the breast check, is that correct? No, I didn't use that figure, I mean that was from the Irish Cancer Society. Okay, and could you give us a figure that you think may have been missed given the... You see, what I'm trying to explain is that if we can get, it depends on how long the interval between when a woman should have been screened and when was screened and as I alluded to earlier, the European Society of Breast Imaging have stated that a 12 week wait does not adversely affect a healthy woman in screening. The real problem for women with breast cancer, and I work in both symptomatic and screening, the real problem for us is to ensure that the younger and the women with more aggressive tumours are dealt with. So that's what we have to factor in. That's why I can't give you an exact figure. We have actually managed right through COVID to deal with all the urgent patients in the symptomatic service and that's been a huge... I'm not for one minute avoiding the question. I'm not for one minute saying there's not going to be an impact. I just can't put a figure on it. And all I can say is that for us, we're very lucky in one way, we have a two yearly screening programme in this country, which was very hard fought. And in the UK, it's a three yearly screening programme. So they're already out at 35 and 36 months for their screening programme. We don't have anybody more than three years. So we're doing everything we can and we will be back up. I believe you are. I honestly believe you are doing everything. The problem here is the lack of capacity and resources. But you did say out of every thousand checks, you would expect to find about seven cancers. Would you not put a figure? It depends. If we look at our screening programme, we should be screening within two years plus or minus three months. So if we look at our backlog over the period for that period, it would be 25,000. And then if we go back to two years plus, I have the exact figures here, if we go back to two years plus six months, then we have a lower rate. So what I'm trying to say is it's impossible to say the numbers because if we get to people quickly enough, then we won't have the adverse effect. I'm just going to give you the numbers actually. If we're not getting to people quickly enough, we could have more adverse effects than what would be normal. Yeah, but what I'm trying to say is we have lost ground both in screening and symptomatic services. And our focus has been to save the maximum number of lives possible, which was to get the symptomatic women done. I mean, under normal circumstances, we would never would have used screening resources to deal with symptomatic women. And even if I was given a huge amount of money tomorrow, we just don't have the trained staff are just not out there. It takes 14 years to train a radiologist. It takes six years to train a mammographer. We weren't expecting COVID. So we have lost ground. I can't pretend we haven't. And it's not a resource issue in terms of money. It's a resource issue in terms of personnel. I'll ask the HSE a question. We're very limited on time here. On the question of staffing, the HSE have said there they added on 3,271 posts. We don't have a breakdown for that. But how does that compare to the number that actually applied for positions from the call for office? From the call for Ireland. Thanks, Deputy. So I can provide a breakdown for that to the committee afterwards. But in terms of the number, which is an end of May number, the whole time equivalent increase. That is reflective of really any, certainly any clinical, clinically trained person who made themselves known to the system and who desired to work in the system during this time period. To understand your question further, you were asking me a percentage, were you? I was asking you to compare that figure with the number that actually applied for positions. So we all know people. I think we all know at least a nurse and probably doctors who are left waiting around for months, having responded to the call for Ireland and didn't get interviews or didn't get posts. And you did say earlier on that the recruitment process is lengthy and cumbersome. So is there, you know, comment on that? Why don't we have more professionals recruited into the system when they were needed and when they were available? I was referring specifically to the recruitment process for consultants, which actually we've looked at streamlining, but it still does take quite a period of time. The recruitment process more generally has actually very substantively accelerated to bring in those 3,200 posts. And in fact, it would be more people than that. Normally that would equate to nearer to 4,000 people. So the system has been seeking to take on everybody it could. If there are individuals who had experienced delay, sometimes maybe issues like guard of clearance or other such matters may give rise to delay. But we have certainly sought to accelerate the process. And the intention in both the hospital and community system overall was to bring on board as many healthcare workers as was achievable to face what was at that point in time an unknown surge level. And would you comment on what the Irish Medical Organisation said this morning, that the two-tier consultancy contract is actually inhibiting recruitment? Two-tier consultancy contract, Deputy? I think we're recruiting into the currently existing consultant contracts. I think maybe the comment might have related, I didn't hear the IMO, may relate to the post-2012 consultant contract. As against the various types of contract that exist. And I understand, though it's not a matter for the HSE, it is intended that that issue would be addressed as a policy issue. So from our point of view, we're recruiting into the currently available contract types. And indeed, on the post-2012 pay scales, I suspect it was a comment on the post-2012 pay scales, which are a matter for government, not the HSE. But having said that, I understand there's a commitment given to review that and address it. Okay, I have a question for the National Treatment Purchase Fund. You say that one third of your work is in securing public capacity. But the problem we have, of course, is that if we continue to rely on the NTPF to solve the waiting lists, we are effectively building up a private system and not dealing with the capacity issue in the public system. So there's a dysfunctional system that we continue to increase, public versus private. And then there's the question of the costs. So what would you say about the efficiency and the costs of contracting out these needs when they actually should be in the public system? Yeah, just to put this in context, and just not going back into ancient history, but NTPF working with the HSE, working with the department, working with the hospital system, we had significantly reduced the waiting lists up to the beginning of this year. And in fact, in the early months of this year, we had arranged surgery procedures and scopes for more than 9,000 patients. We'd arranged outpatient consultants for 8,500 patients. But then at the end of March, because of the pandemic, non-critical care, elective care had to be postponed. And this did definitely have an impact on waiting lists and waiting times. In the last couple of months, since June and this month, we have started to commission again. And in terms of where we are doing this work, whether it's private or public, I think probably the best indicative figure I can give you is that last year, half our money was spent in public hospitals and the other half in private, approximately. So we don't have a particular hang-up as to whether it's private or public. It's not an ideological position with us. We have a simple view of this as whatever works best. And we work very well with our colleagues, as I say, in HSE and in the hospital system to get things down. And we think we can help there again once we get out of the enormously difficult situation that we're currently living in. I could ask my colleague, the chief executive, Mr. Sloyan, whether he wishes to add anything to that. I suppose I would just add maybe that there isn't a reliance on the NTPF to bring waiting lists down. We work very closely with our colleagues in the HSE and the vast majority of treatment of waiting lists patients continues to be done by the HSE in public hospitals. I think the value of a commissioning system, adding on a relatively small level of extra capacity there, is the flexibility and agility of such a system that I think it's the case that challenges arise for waiting lists in many different places, in many different ways, in many different times. And a commissioning system can have the flexibility to address the different types of challenges as they might arise. For example, it may be in one public hospital that they require more theatre time and that can be rented in a private hospital to facilitate them. Others may need more staff or funding to provide work at the weekend or in the evening. And I think what the NTPF and the commissioning system does is that they can look at the different types of problems that have arisen and find a solution to fit that problem. So again, pointing out that the vast majority of waiting lists patients are addressed in the public system through the HSE in Ireland. The NTPF wouldn't exist if we didn't have a dysfunctional public care system. There would be no need for a national treatment purchase fund if we had a fully effective national health service instead of the dysfunctional one we have. I think, Deputy, a lot of health systems internationally have a commissioning element to them. You know, it isn't peculiar to Ireland. And I think it does recognise the fact that sometimes there are temporary problems that need temporary solutions. In fact, all the time, these type of issues arise in waiting lists and they can be different problems. Thank you very much, Mr. Swan. And thank you very much, Deputy Smith. Thank you. Thank you very much. Thank you very much, бер for coming out to you with us. Thank you. Thank you very much. Thank you. Thank you. Thank you.