The Health Service Executive outpatient waiting list initiative was introduced at the end of 2013 for patients who had been waiting more than 12 months who were referred from public to private hospitals for outpatient consultant appointments and treatment. What is the position on the treatment of these patients? It has come to my attention in recent weeks that many of these patients have been told they will no longer be able to continue their treatment under their current consultants and that their files have to be returned in order that they can rejoin the ever increasing outpatient waiting lists at their original hospitals. For example, a young mother, whom I will call Caroline, was referred by her general practitioner in January 2012 to Letterkenny General Hospital for an outpatient appointment with a consultant gynaecologist. Two years later, in January 2014, she was referred under the HSE outpatient waiting list initiative to a private hospital for that consultant appointment, which she attended in March last year. The consultant diagnosed her as requiring surgery. She has been waiting for follow-up treatment since. Last week she received a letter informing her that, unfortunately, the hospital had been instructed by Letterkenny General Hospital that her treatment could no longer continue there owing to financial constraints. The hospital returned her file for ongoing treatment to be carried out within the public sector. The hospital apologised and stated it was completely out of its control. It stated that if she would like to continue her treatment there, she could do so privately and that it would provide a costing for it. Three years after her initial referral she is being put back on the waiting list from which she was referred. There are 1,300 patients in the same situation in Letterkenny General Hospital alone who are unable to have their treatment completed as planned. They are being put back on an ever increasing waiting list from which they had been removed. How many patients are in this position nationally? Will the Government decide to provide the funding required to allow them to complete their treatment, rather than send them back and add them to ever increasing waiting lists in public hospitals?

I thank the Deputy for raising this issue. Obviously, I am not aware of the details of the case he has raised. In the case of Caroline – I think the Deputy said that was her name - he would want to make detailed representations on the specifics of the case to the Minister. I am not in a position to respond here and now.

The Government is committed to reducing numbers on waiting lists for scheduled care, concentrating particularly on those who are described as being a long time waiting, that is, over 18 months. The lady mentioned would fall into that category. The Minister for Health has asked the HSE to develop an action plan to deal with waiting lists, concentrating on those who have been waiting more than 18 months. The plan is to build on work under way and will be available in a few weeks time.

The HSE has also committed in the 2015 service plan to the publication of a waiting list of consultants and at specialist level and aims to reduce waiting lists by redesigning the processes and the way applications are treated. It has put in place specific measures to address waiting lists more efficiently in collaboration with acute hospitals, the special delivery unit and the National Treatment Purchase Fund They include observation of the national waiting list protocol, adherence to clinical programme guidelines and prioritising day of surgery admissions where clinically appropriate.

In the case of elective surgery, the HSE will work on implementing the recommendations made in the Comptroller and Auditor General’s report on day surgery in consultation with the national clinical programme for surgery, with specific reference to targeting increases in day surgery rates in line with best international practice. The waiting list performance will be assessed within the revised accountability framework for the HSE published as part of the service plan. New patient care pathways such as medical assessment, minor and local injury units and urgent care centres, as well as the provision of care in non-hospital settings, are increasingly being used to provide for a spectrum of care which supports the efficient use of hospital resources.

I am not in a position to comment on the details of the case of the lady mentioned-----

Where is the Minister for Health?

By way of a direct query, the Minister for Health would deal with the specific case mentioned.

He is asleep. There were 500 patients on trolleys again yesterday.

He is sleepwalking around the place.

I am not happy that we are not meeting all of the targets set, but it does mean that three out of four are receiving treatment within the target times and that there is significant investment in the development of better practices in order that, in particular anyone, such as the lady referred to, who has been waiting over 18 months, will be dealt with.

The Tánaiste did not answer any of the questions I put to her.

Surprise, surprise.

I did not ask about the Government’s plans, although they are important. I asked specifically about the HSE outpatient waiting list initiative, a previous plan of the Government, which was introduced at the end of December 2013 and through which I have no doubt thousands of people across the country were removed from hospital waiting lists to massage the figures to make them look good. They would have been referred to private hospitals with the intention, as they were told at the time, that their treatment would continue and be completed there. Caroline is but one example of 1,300 who are in the same position in one hospital. How many are in her position nationally? I have made representations about her and thousands of others.

I have taken up the matter with the Minister for Health. In a response to a parliamentary question last week which he had referred to the HSE the answer I received was that it was the HSE's intention that these patients would receive their treatment in a timely fashion in the hospital to which they had been referred. The funding required for it to proceed with this plan was not provided; therefore, it is now taking steps to add these patients back to the public waiting lists for ongoing management and treatment. It is in the process of communicating with these patients to provide for them accordingly. That is what I am asking the Tánaiste to explain. There are 1,300 cases in County Donegal. I have no doubt that on the street next to the Tánaiste’s there is a patient and that there are many patients in her neighbourhood in the same position. Is she aware of this case?

I am not aware of it.

Will the Tánaiste tell us how many are in this position of having their files referred back? Will she commit to providing the funding these patients were told would be available to complete their treatment under the consultant who is currently treating them?

The Deputy is already in discussion with the Minister for Health of the details of the cases mentioned. I do not have the details of all the numbers which would be available to the Minister for Health.

As I said, the Deputy should continue to discuss it with the Minister who has the details.

Will the Tánaiste take up the matter with him?

It is the Tánaiste's initiative.

The Tánaiste has the floor.

On waiting lists, the number of inpatient and day cases at the end of November 2014 was 61,000, of which 12,500 had exceeded the target waiting time of eight months for a procedure-----

That figure does not include the thousands about whom I am speaking who were removed from waiting lists.

-----while the cases of more than 2,000 children had exceeded the target paediatric waiting time of 20 weeks for a procedure. As I said, three out of four receive treatment within the target times. However, that is not satisfactory and it is the job of the Minister for Health to improve it.

There are thousands of people who are not receiving treatment.

In 2014 the number of patients waiting in excess of 12 months for an outpatient appointment was over 55,000. Again, while I am not satisfied with this, it does mean that approximately 85% of outpatients were waiting less than 12 months for an appointment.

The Tánaiste is massaging the figures. They are not accurate.

Up to the end of November, there had been a 3% increase in outpatient attendances, as compared with the figure for 2013. This means that 98,000 more patients were seen. The reality in the health service is that the vast majority of patients are being seen. I agree with the Deputy that for anybody who has been waiting a lengthy period to be seen, it is distressing and that changes to their care treatment plan may be very difficult for them. I will take up the matter with the Minister for Health on the Deputy's behalf.