Martin Daly: Use hospital capacity or end long waiting lists

Thank you Minister, I suppose this fits in with the rest of the debate that's going on here. It's just to ask you about the targets for the inpatient waiting times and I want to acknowledge your focus on productivity, your focus on reform within the health service. I think Deputy Neville has pointed up an area that all of these things, it's an ecosystem, are interconnected and if you cannot have an efficient admission and discharge policy both for inpatient and for acute elective and acute, you're going to end up with long waiting lists. Thank you Deputy, I propose to take PQs 1, 2, 3 and 1, 3, 6 together. So look, improving access to healthcare in our hospitals is an absolute priority for me. As you know that we have very good outcomes in our healthcare system. Our challenge is making sure that we have access as quickly as possible, so that is the focus on making sure we're using our resources in the best way possible. We are focusing on a public healthcare system and where everybody has timely access to high quality scheduled care, where they need it, when they need it. The waiting time action plan for 2026, which of course used to be the waiting list action plan until we all realised together that time is more important than the number of people, the length of time that we're waiting is more important than the number of people on the list, obviously, but this builds on the progress to date, including significant reductions achieved in the length of time patients are waiting. The plan takes a multifaceted approach in achieving it, setting out six overarching and interconnected targets focused on patients waiting the longest. The plan aligns with the NSP targets for planned care, including targeting increases in the proportion of patients waiting within slaughter care maximum waiting times and outpatient and inpatient day case waiting lists. Those targets represent steps towards our ultimate shared goal of all patients being seen or treated within the slaughter care target times, 10 weeks for outpatient appointments, 12 weeks for inpatient and day case procedures. The devolution of responsibility to the regional executive officers is a really important part of this reform, because they have complete visibility over what's happening with their acute hospitals, with their model four, model three, model two hospitals and everything that's happening in the community and in their primary care centres. There has to be an absolute synergy between the different model hospitals and primary care to use this. We now have tools that we didn't have before. We have the outpatient toolkit, which is showing what the actual room utilisation is in every hospital. There should be no resistance to the application of the outpatient toolkit. It is not tenable that some hospitals have room vacancy rates of between 4% and 9% during the week and 24% on a Friday afternoon. I haven't seen yet what the room vacancy rates are on a Tuesday evening or a Sunday morning, but we do not need to build more capacity and more rooms until those rooms are filled and being used, because they're being heated, they're being insured, they're being all of these different things, they're all there and available. So the utilisation of the outpatient toolkit is enormously important and it means that we are scheduling according to the most efficient use of time. We're not asking people to change the length of their consultations. We're not asking people to change the nature of their medical practice. We're simply taking the length of time that they normally use and just reorganising things so that it is done differently and delivered differently, including, importantly, in primary care centres. This really matters because we have the opportunity between the outpatient toolkit and now the surgical hubs in respect of inpatient day case procedures or a certain proportion of those and also freeing up the corresponding activity in the home hospital. The first real application of that, of course, will be with the Dublin North East surgical hub, which I think is a huge opportunity to test how the public-only consultant contract is being used or not used, rostered or not rostered, how the 5 over 7 is complementing that and how that is being used by all of the different hospitals in the Dublin North East region. So we have these different reform opportunities but it's really important now that they are delivered. I want to highlight the importance of clinical leadership in this. Every single person in this house is calling for and looking for the same thing. It has to be implemented and there is a clinical leadership responsibility that must stand up and make sure that the clinical community are doing everything they can to adapt and change their ways of working within the contractual parameters that they have signed and that have been set in agreement and that they have signed to make sure that we're delivering for the patients of Ireland. There are brilliant people working in the public health service who do their work very well but we can acknowledge and I think you acknowledge there are areas of the country and some hospitals where that productivity isn't apparent and I speak about HSE West North West, which you've acknowledged in the past at the Health Committee, where there are issues around discharge and management of patient flows. But I have to say this, in the poorest region of the country with the highest proportion of the population in receipt of disability payments and the highest proportion of the population in the country in receipt of a full medical card, we have a situation where we can't discharge patients from a level 4 hospital UHG because there aren't any step-down beds, there aren't enough rehab beds and there isn't enough home health hours. In addition to that, we have a level 4 hospital that is purporting to carry out all the services of a level 4 hospital without that capacity and we do need commitment to a new hospital in the West, in Galway, in UHG. In addition to that, we have a situation where there has been an over-reliance on the private developer delivered private care centres and also an over-reliance on individual GPs to actually deliver that infrastructure. If we're absolutely serious about the interconnectivity of our health service, we need to get some of that investment into primary care and it is my view that the vast majority of the very considerable investment by the state over the last five years has continued to go into hospital and acute care and not enough into developing primary care. We have the longest waiting list for speech therapy, psychology, community physiotherapy and speech and language therapy in the community and unless we fix that capacity in the community in tandem with the acute service, we will not see the end of these waiting lists. I agree with you, that's what we're trying to do. On the primary care centres, we have 181 at the moment with eight under construction and 21 more in earlier planning stages but if people don't use them and if they're not used for outpatient procedures to relieve hospitals, to relieve pressures on hospitals, then we're going to keep having the same conversation. So you have an excellent outpatient centre in Merlin Park right beside UHG and it is one of the few that is being used on a three session day but there's more that can be done. There's a lot more that can be done and they have done good work in that primary care centre to do that but there's more that can be done there. So this is about how people are working as much as where they're working. I've talked about the physical capacity increases that we have but we cannot keep building more physical capacity if people aren't going to use it differently and there is no point in concentrating consultant work between nine and five, Monday to Friday, with all of this additional capacity. I would rather spend money hiring more people to fill the space, the spare space, but how can we be sure that that's going to happen if the clinical leadership don't make sure that we're implementing the contract such as it is? Then we have to see evidence of that, we have to see the trajectory in relation to that, we have to see clinicians, you know, and as you acknowledge and I absolutely agree of all of the really fantastic people doing fantastic work but we can't keep saying that and also know that many of them also have to work differently towards the future to make sure that we're using the space that we have all paid for to make available for the benefit of patients. We cannot have primary care centres that are closing at 5pm, they have to be open until 8 and 10pm and serving the community and this is what they're for. So this is about building capacity, yes and it always will be in a growing population, but at some point we're going to reach a point where a juncture where we have built so much capacity, if we have all of this evidence of it not being used or not being used in the most balanced way across the week, then we're going to have to start asking ourselves decent questions about it. I have a situation where I have a patient at the moment who has critical ischemia of her leg, it's a hard-working woman in her 60s and twice she's had to be admitted to hospital, twice sent out, she needs a procedure done. She's now sitting for two weeks in a bed in UHG because they can't get theatre time to do the procedure that she requires. Now that's simply not a productive system and we have people who have literally given up on certain specialties in the west of Ireland because they can't get access in the areas of dermatology, rheumatology and some of the other specialties. So we do need, I absolutely agree with you and you have my full support for any reform around productivity, we also do need to deal with the fact that our health service has not been digitalised. We are off the record, the compass 2030, EU compass 2030, where patients will be fully, have fully digitalised records in every country in the European Union. Ireland is so far off that chart and countries like Estonia, Malta, Lithuania can do this and we can't do it and we really do need to focus on enabling productivity and you're absolutely right, we should be using our physical resources insofar as we can but there is an issue around UHG and we do need a new hospital there over the next 10 years in order to make sure it functions properly as a level four because that's the type of specialty treatment that someone needs but they're competing with people who go through the emergency room, elderly people who need care in the hospital setting, who might be better cared for in a community setting but we have to deal with primary care and finally we need to get over the culture that because it is a contract-led service by GPs that that infrastructure should be borne only by GPs. If we're absolutely serious we should be building state-led primary care centres and have five-year rent-free zones to attract young GPs into those centres. Yes Deputy, as I said we have 181 of them, eight in construction and 20 more at early planning stages for precisely that so I do agree obviously. As to your constituent who couldn't get her surgery because, let's just count up the different things we've said here, they can't get theatre time for her. Okay, there's a theatre utilisation project, I would very much like to know the nature of her procedure and I would very much like to test that against the theatre utilisation across that hospital. You say that we need a new hospital, can I point out and remind that we are building both a surgical hub and an elective hospital for precisely additional theatre time so can we just make sure that we're staying aligned to exactly what's going on? Full utilisation of all of the theatres in UHG, a surgical hub, an elective hospital, I mean can you imagine the number of consultants, the number, can you imagine the number of surgeons it takes to run those all the time? If we were seriously running those seven days a week, how many consultants does, how many surgeons does it take to run a surgical hub all the time, recognising that they're not all going to be doing it all the time but that there'll be, you know, two or three shifts across it, an elective hospital and all of the theatres that are already in UHG, how many surgeons does that take? Can I strongly recommend to the members of the health committee who are here that you invite the team that have done the theatre utilisation project and the OPD toolkit and interrogate them as to their findings, their use of theatres and see this for yourself, see this for yourself and then come back and, you know, let's look at what is the serious number of surgeons it takes to fill six surgical hubs, four elective hospitals and every theatre in the country. When we were doing the endometriosis project, urgent project to get more surgeries, I was looking for an additional 100 surgeries in the final quarter of 2025. One of the responses that I got in relation to it from a surgeon who really is invested in this and really is working hard was that one of the barriers he had was that he was told that you couldn't do elective work after 5pm in the theatres in the maternity hospital that he was working in and I was, I'm sorry, what says who? So these are some of the barriers that we have to overcome, we have a lot of space, we have to use it.