Following the "RTÉ Investigates" programme last night, it is clear to me and everyone else that the HSE is dysfunctional. Is the Taoiseach, a former Minister for Health and a doctor, not mortified and embarrassed that on the show last night, Mr. Stephen Cussen from Limerick stated, "I pray every night that God will take me"? He says this because he is in so much pain. He has been waiting for three years for an outpatient appointment for a knee replacement and he is in severe pain. Stephen is waiting for a public appointment in Croom Hospital, which has a three-year waiting list. If a person pays for private treatment, he or she would be seen in six months.

There are 2,700 consultants working in 47 acute hospitals across the country. A vast amount of doctors do great work, as the Taoiseach knows, and they would do more if the facilities were there to allow them do so. In 2008, a new consultant contract was introduced so anyone who signed up to this was limited in the amount of private work they could do. They were offered enhanced salaries to accept that contract. The aim of this contract was to control private practice in public hospitals and stop doctors going off-site to private hospitals. In this contract, a consultant was to do 80% public work and 20% private work in a public hospital to ensure private work was limited. The opposite seems to be happening in some cases and the public waiting lists are only getting longer.

Mary, who is 75 years old, was on the programme last night and she had to sell her jewellery in order to have a cataract removed because she was blind in one eye and had ailing sight in the other. If she did not sell her jewellery she would have been on a two-year waiting list to have the cataract removed. Once she had the money to go for private treatment, she was seen within two months and paid €1,800 to be seen in the same hospital where she would have had to wait for two years. In the Limerick hospital where Mary was waiting, there are 1,272 people waiting for a cataract operation, with 407 people waiting more than 12 months. It was revealed last night that consultants in Limerick had a 30% private case load, which is way over the 20% level allowed in the contracts.

In 2016, almost 24,000 private patients were seen in public hospitals in Ireland. That means in the past two years, almost 48,000 public patients have lost out to private patients in a public hospital system. There is something wrong with our health system if we are encouraging people to travel north to Belfast to have procedures carried out privately. Once they come home after the treatment with a receipt in their hands, the HSE will refund them the money. I have numerous constituents awaiting procedures, including knee, hip and cataract operations. One constituent is going blind waiting to be seen but the HSE has only said that the patient should travel to Belfast and the money will be refunded afterwards. Would any member of the Cabinet be happy for someone close to them having to sell their possessions in order to have a simple procedure like a cataract operation carried out?

I saw the programme last night and it was a very interesting piece of high quality investigative journalism, examining statistics and following individual consultants in the course of their work. I would like to say I was surprised by the outcome but there has been anecdotal evidence for a long time in the health service of a minority - perhaps not a majority - of consultants not fulfilling their contractual obligations. They are not doing the public hours they are paid for and are seeing more private patients. The practice is deeply offensive and it must change.

I remember when I was Minister for Health I asked for an audit to be carried out of accident and emergency department consultants to see how many patients they saw. This arose because of a tip-off from other department staff who were concerned that consultants were not seeing very many patients who came in the door. They were seeing patients in review clinics and private clinics relating to legal reports. They did not see the people coming in the door from ambulances in big numbers. To my knowledge, that was never done. In many ways, what we saw last night speaks to something I have raised on many occasions.

That is something this Government now has to deal with.

On the issue of waiting lists, the Deputy may not be aware that the waiting list for procedures for inpatients and day cases has now fallen for three months in a row. Part of that is down to the additional resources we are putting into our public hospitals. Much of it is down to additional funding for the National Treatment Purchase Fund, NTPF, and I believe we will see waiting times falling for cataract and procedures such as hips and knees falling in the year ahead. Between April and now, the overall number of people waiting for an ophthalmology procedure fell from 13,552 to 11,863, and the cataract waiting list has fallen from over 10,000 to 8,667. We are starting to see results in terms of the additional money being given to the NTPF, and also the additional funding provided for insourcing, to do more work in our public hospitals.

On the fundamental issue, the Sláintecare report and the all-party report on the reform of health, one of the recommendations was that we take private practice out of public hospitals. I agree with that; it is a good idea. The report recommends that a commission be established to examine how that would be brought about. It would be costly at approximately €700 million in a year and would involve changes to contracts. The Minister for Health, Deputy Harris, has already appointed that group, which is headed by Donal de Buitléir, to examine exactly how we can do that. It would be - if and when it happens - a game changer for our public health system. We would never allow what happens in our public hospitals to happen in our schools. Children could not come in to be taught in a private class with fewer pupils and a teacher who is paid more to teach them. We would never allow that, yet we allow it in our health service. I do not think we should. It means there are perverse incentives for hospitals to have more private patients because they can then generate additional revenues. Our public hospitals get about €700 million in additional revenues. In addition to that there is a perverse incentive for the individual consultant to make more money in that way. It has to change.

Did I hear the Taoiseach correctly when he said that the audit he sought as Minister for Health was never actually carried out? If that is a fact, surely now, in light of the information highlighted by "Prime Time", the Taoiseach will direct his Minister for Health to ensure an audit is carried out to find out what the consultants are doing to reduce the lists. Are they, in fact, working in a private capacity to the detriment of the people waiting on our public list? That is of paramount importance.

The figures the Taoiseach quoted regarding the waiting lists shrinking are explained easily. The lists are shrinking because people have no choice but to go private. People are selling their possessions to go private. I have the figures for Cork and Kerry. Some 517 patients are waiting to be seen in Cork University Hospital outpatients clinic for ophthalmology review. Some 113 patients are waiting for cataract surgery in South Infirmary Victoria University Hospital. That is 630 people from the county of Kerry who have trouble with their eyes and nothing is being done to help them. What, in light of the programme last night, is the Taoiseach and the Minister for Health, Deputy Harris, going to do about this very serious situation?

The audit was not done before I became Minister for Social Protection. Perhaps it was done subsequently. I will check up on that. It is certainly something that I raised regularly in meetings with the Irish Hospital Consultants Association and the IMO. They would always deny it and say that it was a very rare practice. I do not think it can be denied any more. The Deputy will know that in this House there was huge controversy when we required Deputies to clock in to ensure that we knew that they were on the premises.

There was not.

Whether they were working or not could not be proven.

The Taoiseach should speak for himself.

There was some controversy at least. I do not think it would be a huge imposition on our hospital consultants to clock in so that we at least know they are on the premises and are not in private hospitals when they should not be.

We are doing exactly what was recommended in the Sláintecare report. We have established a group under Donal de Buitléir to examine how we can separate and take private practice out of public hospitals, what it would cost, what the implications would be and how it would be done over a period of years. That is the fundamental action in terms of long-term reform. In the interim, for people waiting for cataract operations and hip and knee operations, we are giving additional funding to the NTPF to allow those patients to go privately. The NTPF does not just fund private hospitals. It also does insourcing as well in places such as the Eye and Ear Hospital, for example, and Cappagh. The number of people waiting for inpatient and day case procedures has fallen for three months in a row because of that. I will drive that forward and make sure it continues to fall throughout next year.