ORTHOPAEDIC SURGERY WAITING LISTS UNACCEPTABLE – SMITH

Cavan/Monaghan Fianna Fáil TD, Brendan Smith, during Health Parliamentary Questions in Dáil Éireann highlighted the urgent need to reduce waiting times for orthopaedic surgery in the North East, particularly in Cavan/Monaghan.

Deputy Smith told Dáil Éireann – “there is a problem with waiting lists for orthopaedic surgery in the north east, and the problem is particularly acute for patients in the Cavan-Monaghan area. Of the total on outpatient waiting lists in the north east, 43% are referred through Cavan General Hospital and they are awaiting appointments and assessments by orthopaedic surgeons. There is an urgent need to increase the orthopaedic capacity in the north east.

Constituents have been making an increasing number of representations in the past two years concerning people, particularly those in the older age cohort, who need care and attention or surgery in respect of hips, knees and shoulders. In many instances, when people are suffering a particular ailment and are awaiting orthopaedic treatment, this drags down their general health, as the Minister will appreciate better than most in this Chamber. GPs in the Cavan-Monaghan area tell me that when they refer a patient to, say, Navan, they typically wait up to two years for their first assessment, although that is through no fault of the surgeons in Navan. In the meantime, their health can deteriorate.

The patients referred through Cavan General Hospital catchment area make up 43% of the patient waiting list in the north east, and 90% of those are waiting longer than 12 months. It is a very acute problem in Cavan-Monaghan and I would like some particular initiative to try to deal with this backlog.

Cappagh Hospital is an important hospital for the north east, as well as the hospitals in Navan and Drogheda. My understanding is that two years ago or less there was a reduction in bed capacity at Cappagh. Did the Minister say the capacity had been increased in Cappagh?

A comment was made to me by one GP that if GPs were in a position to carry out injections into joints, in many instances that could ease people’s pain and suffering. As the cost of this injection is quite high, the typical GP in a small practice with a patient on a medical card would not be in a position to provide that service without some additional remuneration. The point made to me was that it could ease the immediate suffering for the patient concerned and perhaps also ease pressure in terms of referrals to hospitals. It might be considered”, stated Deputy Smith.

Minister Varadkar in his reply stated – improving waiting times for scheduled care is a key priority for Government. In January, I put in place maximum permissible waiting times for inpatient and day case treatments and outpatient appointments of 18 months by mid-year and 15 months by the end of the year. As of 30 June, the HSE is reporting a 99.6% achievement against the maximum permissible waiting time for inpatient and day-case treatment and a 96% achievement against the maximum permissible waiting time for outpatient appointments.

In respect of orthopaedic services in the north east, a national initiative was introduced in 2013 which provides physiotherapy triage of patients on orthopaedic OPD waiting lists. As a result, approximately 40% of patients are getting earlier intervention. The national trauma programme is also looking at orthopaedic services nationally to determine recommendations for managing both trauma and elective workloads.

Our Lady’s Hospital Navan and Cappagh National Orthopaedic Hospital provide the majority of inpatient and day-case elective care for the north east. Navan Hospital is close to maintaining a six-month inpatient and day-case access time, which is relatively good. Cappagh National Orthopaedic Hospital has received an additional allocation of €3.8 million this year. Consequently, activity in 2015 has exceeded 2014 levels and will continue to improve month-on-month to the end of the year. This has resulted in a gradual reduction in access times. Both hospitals have met the current maximum permissible waiting time of 18 months at the end of June 2015 and anticipate that they will be compliant with the 15-month maximum permissible waiting time by the end of this year.

The particular initiative that has occurred in the last few months is additional capacity, where possible, within the public system and the outsourcing of some patients to the private sector, where they were waiting more than 18 months. On the outpatient waiting list figures, there are about 50,000 people waiting for orthopaedic treatment, but the largest single category within that are waiting less than three months, some 16,000 people. Approximately 9,800 are waiting three to six months and 14,000 are waiting between six and 12 months. The number waiting over two years is much lower, but any of those should have been picked up in the last few weeks and should have appointments by now, if they do not already. If the Deputy knows of cases of people waiting over 18 months, I would be interested to see them. If the Deputy wants to pass them on to my office, we will certainly check them out, because that should not be the case at this stage.

As the Deputy knows, GPs can inject joints, provided they are sufficiently trained to do so. They often do not do it for medical card patients because it is not economical to do so. One of the items that will be under discussion in the new contract talks with the IMO, which are due to start shortly, is that of changes to what are called special-type consultations – the additional fees that GPs get for suturing a wound, injecting a joint and the like. That is certainly one of the things that can be negotiated as part of the new contract.

Because of the budget cuts, Cappagh was very restricted last year and, at one point, only two of the seven theatres were open. Now, because of the additional finance we got this year, of which Cappagh got an extra €3.8 million, four or five of the seven theatres are functioning.

[Deputy Leo Varadkar:  ] That has allowed it to increase capacity. I would like to get them all open but the issue we are not running into in Cappagh is a shortage of theatre nurses. That is a further barrier but there is an increase in activity”,  concluded Minister Varadkar.

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