I move: “That the Bill be now read a Second Time." I am not surprised the Government has indicated that it will oppose the Bill. The previous Government signed up to Sláintecare a number of years ago. I was always suspicious of Fianna Fáil and Fine Gael signing up to a plan that delivers universal healthcare and seeks to streamline and reduce waiting lists. I contrast that ambition with the evidence of almost 1 million people currently on some form of waiting list, if we include acute, community, diagnostics and so on. In the past, my party put forward clear plans for an integrated waiting list management system. We had some favourable responses at the time from Simon Harris when he was Minister for Health but, of course, they never saw the light of day. It is troubling but not surprising that the Government will oppose this straightforward but very important legislation. The Bill seeks to do things: first, to acknowledge that waiting lists are too long and, second, to bring a degree of transparency to those lists that does not currently exist. Going back to what I said a few moments ago, almost every Member of the Oireachtas at the time Sláintecare was put in place signed up to that plan. We signed up to a roadmap, in essence, to deliver universal healthcare. It also set statutory timeframes for waiting lists that we are absolutely nowhere near meeting. I raised directly with the Minister for Health a number of weeks ago the situation with even very basic daycare procedures in my constituency of Waterford. Patients come into my office almost daily for cataract, hip or hernia operations - very basic procedures. When I contact local hospital management, they say, unfortunately, the person could be waiting 12, 15 or 18 months. For a patient who needs a cataract procedure, that has an impact because it affects their sight and their quality of life. One gentleman I was dealing with needed two cataracts done. Thankfully, after a lot of lobbying of hospital management, we eventually got him seen through the NTPF and he will be seen that bit quicker. If he was left on the waiting list, we were told he would wait at least 15 months for that to be done. That is the reality people are dealing with. I make that point to reinforce what I am talking about here. There was a lot of excitement when Sláintecare was agreed. Deputy O'Reilly was the representative of my party on the committee at the time. A huge amount of work by many people went into ensuring we set out a roadmap that could transform our health service and deliver the type of health service people want. That is one where people do not have to wait years for basic procedures, or for serious operations, which is also the case, or for speech and language therapy, occupational therapy or access to a dietitian. All those community waiting lists have also got very long in recent years. We currently have 250,000 people on community waiting lists. It is staggering. The vast majority of them have been waiting over 12 months and, in some cases, over two years. We have to juxtapose that with the Sláintecare targets, according to which people should be seen within a matter of weeks. Instead, they are waiting years in some cases. What does our Bill seek to do? It requires the Minister to set priorities for the HSE with regard to maximum wait times and to set specific targets. We want those targets to be the Sláintecare targets we agreed to. The Bill specifies 12 types of service for which there should be maximum wait times and allows the Minister to specify any other service. The Minister must have regard to the Sláintecare report, best practice, outcomes and the effect on services of specifying maximum wait times. The maximum wait time targets are not specified in the Bill because we deliberately gave the Minister flexibility and allowed her to set what she might see as more realistic initial targets as we move incrementally towards implementing the Sláintecare targets. Why that is being opposed I have no idea. The Minister and Government will have to explain why they are so far behind their Sláintecare targets and why people are waiting so long. When we in opposition come forward with solutions, which we have done in this area, they get knocked back time and again. It does not make sense to me in relation to some of the proposals we have been calling for for years. They include an integrated waiting list management system to better utilise all resources across all hospitals so a person is not referred to a single doctor and waiting on that doctor's list unable to be seen by a different hospital or even a different doctor within the same hospital. Having that integrated system would mean patients could be offered procedures much quicker, yet that does not happen. We saw recently with the scandal of insourcing the concerns, challenges and difficulties posed by single consultants managing waiting lists rather than their being managed by a hospital or hospital group or being centralised in some way. Having a local list but also a centralised list makes sense. We have been calling for that for so long, yet it has not been implemented. I also seek in this Bill to bring a greater degree of transparency to waiting lists. At the end of every month, the NTPF publishes some waiting lists. It publishes the acute hospital waiting list, which is very welcome, but it does not publish diagnostic waiting lists or community waiting lists. It does not cover mental health waiting lists, CAMHS or any of the other areas of social care and healthcare where people are waiting. We have to put in parliamentary questions to get that response. It is the same with dental treatment. I got a reply to a parliamentary question recently. I had to ask the question three or four times to get the information I was looking for. I eventually got it but that information should be transparent and clear and on the NTPF website with the other waiting lists for acute hospitals. It beggars belief that with all the new technologies in the healthcare system, we still do not publish all the waiting lists with wait times. They should be broken down by region, county and area. That would give all of us a chance to see which areas are performing and which are not, where pressures exist and where pressures do not exist. We can then praise those efforts which are achieving better results. An example is in my constituency of Waterford, where the hospital is one of the better performing hospitals. Wait times are down. People are not waiting on trolleys in emergency departments in the same way they are in other hospitals. It is good for all of us to see what is and is not good practice. Transparency around waiting lists shows up that there are sometimes regional differences, not because management or staff in those areas are not doing their best but because we do not have the staff. We might not have the equipment, resources, capacity or whatever it might be. That is mostly the reason we have those types of regional disparities. If we do not have the waiting lists and cannot measure or compare, obviously that is not good. I have always said data is really important in the healthcare system. If we have very good data, we can do so much more. I was at a meeting of the Oireachtas health committee a number of weeks ago. I am not sure if the Minister of State, Deputy O'Donnell, was at that session on digital transformation and the roll-out of the unique health identifiers and electronic health records, EHRs, all of which we are told will happen over the coming years. It will take six or seven years for the full bells and whistles of the EHRs to be in place and for this State to have digital hospitals. While that is being done, it is the perfect time for the State to get its act together on waiting lists. I have seen so many waiting list initiatives from Governments. We could paper the walls of this place with all the winter plans and waiting list initiatives - money thrown at the system, money for insourcing, money for outsourcing. Yet when we look at the waiting list, we see people are still waiting far too long and we are nowhere near the Sláintecare targets. We have to start looking at outputs and asking why, with record investment in healthcare, we are still not getting the results we need or seeing waiting lists come down to the extent required. It is partly resources and capacity. If we do not have the staff, beds, physical space or equipment, we cannot provide the surgeries or procedures or make appointments as quickly as they need to be made. Equally, if the processes are not working or are cumbersome or protective and create little fiefdoms where people control waiting lists and there is not freedom to move from one waiting list to another, that does not make sense. It does not make sense to me or to a patient waiting for a hip procedure in Waterford when there may well be an opportunity to be seen in Kilkenny, Wexford or somewhere else quicker. Why are those opportunities not being made available? Why are we not harnessing that potential and using the full resources of the health service we have? Again, there is evidence of good practice in this area. I go back to my constituency. I was part of a group of Oireachtas Members who met monthly with hospital management and the regional hospital group. We forced them to have better engagement with the local private hospital, UPMC Whitfield, doing a lot of elective procedures and diagnostic work. They bought up beds in private nursing homes and contracted beds to ensure speedier discharges. They also put better systems in place to manage waiting lists and for better collaboration between consultants and staff for discharges and so on. Processes do work. Flow in a hospital is important. Flow in the healthcare system is important if you get it right. What is frustrating is we see evidence in other countries of the solutions we are proposing to fix the problem and to integrate and manage waiting lists in a much more productive way, yet we have a Government that simply will not accept them. It says all the right things and offers nice words when we raise this but then it does not happen. I will be interested to hear the Minister of State's speech and to hear exactly why the Bill is being opposed. There may be some good reason for it. This is a Bill we got a lot of help with putting together to ensure it was as fit for purpose as it possibly could be. I am sure the Minister of State may have been in opposition himself at some point. We do not have the resources a Department has or an army of civil servants to do a Bill, so we do our best, as the Opposition, to craft Bills that are as fit for purpose as possible. Even if they were not ideal or perfect, the reason we have Committee Stage in Bills is so that, if there are any issues, they can be discussed, amended and got to a point where we have more fit-for-purpose Bills. I will finish on this. I have not spoken to the Minister of State and I do not know why the Bill is being amended but for whatever reason it is being amended, I hope he is coming with an alternative and not just coming again to say "No" to the solutions we are putting forward. I do not want to be here in five years' time again still talking about problems with managing waiting lists or about people waiting too long; still waiting for the elective hospitals to be built or the 3,000 beds that Stephen Donnelly promised, which we will not see delivered over the next five years; and still looking for transparency around mental health waiting lists, community waiting lists and so on, where I have to put in parliamentary questions again and again and ask them in a dozen different ways to try to get the information I want. Surely the Minister of State is going to respond by setting out a plan in relation to greater transparency with waiting lists, and a better way to manage them as well.

Sentiment score: 0.12

If I was in government and was handed a script like the one the Minister of State was expected to deliver this evening - I assume by officials in the Department, but I do not know who crafted the speech - I hope that I would say, "No thank you, I am not going to read that out." It was embarrassing in the context of the reasons given for opposing this Bill. It is embarrassing for one simple reason, namely it is what the Minister of State and the Government signed up to. It is what we all signed up to when we agreed Sláintecare. An Teachta Rice is right. It is alarming that the Government is clearly stating that it is walking away from a commitment given to put in place statutory waiting list targets and maximum waiting list times. The Minister of State is mixing up policy and policy targets, on the one hand, and statutory targets, on the other. That is the difference between what this Bill seeks to do and what he outlined. What we see routinely from this Government are HSE service plans. These are produced every year but are not worth the paper they are written on because the HSE does not have the capacity to meet any of the targets. Almost every target that is set is broken. The Minister of State cited all of the targets set out even in the most recent waiting list plan to reduce wait times in some areas by 50%. Nobody out there, not even the people who wrote the script for him, believe that is going to happen. All we have are these published fantasy targets. It is a case of "We will see what is going to happen, but we are not going to do anything and do not really care." That is what I hear from Government. Before I get into some of the process issues behind the Bill and the reasons I think the explanations the Minister of State gave are utter nonsense, I highlight the fact that I am also of the view that we will not reduce waiting lists until we put capacity into the system. We have to build the four elective hospitals. We have to deliver on the hospital beds. We have to deliver on the diagnostic capacity. We have to upgrade equipment. We need new equipment in some hospitals, and we need staff. We need to train more healthcare professionals to fill the gaps where there are staff shortages. All of those are obvious ingredients when it comes to reducing waiting lists and providing faster care. In the context of Sláintecare, it is understood that process is important. Setting targets is also important, however. I do not believe we will ever solve the problem in emergency departments and have a situation where people will not be left on trolleys if we do not adopt a zero-tolerance approach. That is precisely what happened in Waterford, where the hospital manager at the time said that one person on a hospital trolley was one too many and adopted a zero-tolerance approach as a result. He did not believe change would happen overnight, or in a week or a month. However, if we set it as a target, the entire system - the staff, consultants, nurses, healthcare assistants, radiographers and everybody working in hospitals and in other parts of the healthcare system which are crucial in the context of reducing crises in emergency departments and identifying what the capacity needs are - will be forced to get us to a point where we do not have patients on trolleys. That is precisely what happened and it would not have happened if a zero-tolerance approach had not been taken. It is the same with the maximum wait time targets. The reason Sláintecare set those targets was that it was believed, on the advice of the Department, the HSE and all the experts who came before the special Oireachtas committee that looked at Sláintecare, it was possible to do it. The purpose of setting a maximum wait time was to force the system to put the capacity in to meeting that objective. The Government is now walking away from that. The Minister of State shook his head earlier when he indicated it was not but clearly it is. The reason he gave for opposing this Bill was that the Government did not have to accept this because it was doing it anyway. It is not doing it. It does not have statutory targets. I do not know if the Minister of State could point to me where on the Statute Book the Government has ever legislated for the Sláintecare targets. I know it has not done so. Coming then to the community waiting lists, I find the Government's response on those even worse, and breathtaking in many ways. It is an acceptance of utter failure by the Government. It is really saying it cannot publish the community waiting list times through the NTPF, in the same way as the acute hospitals, because we are not up to that standard yet. What an appalling response and appalling situation for us to find ourselves in. We have children and adults on those waiting lists waiting for access to dentists, dietitians, speech and language therapists and all the other community waiting lists. We get those responses back through parliamentary questions. They may not be perfect, and I made that point earlier, but at least we get numbers. It is possible for Government to publish those waiting list times. If they are imperfect and need to be improved or brought up to a standard similar to those for the acute hospitals, that can happen over time and evolve. However, simply to say we are not doing it because we do not believe we can do it to the same standard as acute hospital waiting lists is not a satisfactory response. We have an entitlement to the highest levels of transparency. I imagine it frustrates patients that we spend tens of billions every year on health and yet there is basic information we cannot collate or publish. I will finish how I started. If I was in the Minister of State's shoes, I would have handed the speech back and said, "No thanks, I am not going to read that out" because it essentially tells the public the Government is again walking away from one of the key proposals and action points it had in accepting Sláintecare. That is regrettable. My party remains committed to Sláintecare and to the highest levels of transparency in the health service for waiting lists. We also remain committed to people getting timely, fast and rapid access to care, as best we can. This will not happen overnight and there is a lot to be done to get to a point where we can reach those targets. Unless we take targets seriously, however, which the Government is not doing based on the Minister of State's speech, and use those targets to mobilise and marshal the resources of the health service to meet them, patients will continue to wait. I gave the examples of patients waiting for cataract, hip and hernia operations, which are standard day-case procedures in most cases, but there are others, including cancer care, cardiac care and so on. I am disappointed the Minister of State is not accepting this Bill. I will take this up with the Minister for Health.

Sentiment score: -0.01