Deputy Flaherty gave me notice of her intention to raise on the Adjournment of the House the subject matter of the critical situation in Crumlin hospital regarding heart operations. Deputy Flaherty has some 20 minutes in which to make her case and the Minister has ten minutes to reply.
Dublin Children's Hospital Heart Operations.
Thank you, a Cheann Comhairle, for giving me the opportunity to raise this matter. As you know, I have been seeking to raise it for the past three weeks. First, I am rather disappointed that the Minister is not present to deal with this very serious issue for which he has direct responsibility. I raise a matter of deep and widespread public concern. At present there seems to be a question mark over whether this State will provide the necessary number of operations to ensure that infants and children are given life-saving operations when they require them. That this is something which has to be considered by the Minister — he indicated in the House some weeks ago that it was to be given special and urgent consideration — is an indictment of the Government and an offence to moral conscience and the commitment to life of the Irish public.
Concern was raised initially by Professor Conor Ward of Crumlin hospital who, speaking to the Royal College of Surgeons in Ireland, stated that Our Lady's Hospital was unable to meet the demands for heart operations. We have been witnessing cutbacks in our health services over the past two years, but the situation which has emerged in regard to Crumlin hospital is unique in that three of the senior medical people involved have put their reputations on the line and stated categorically that they are unable to deal with the situation. Professor Ward indicated that they had need for 300 operations a year, that the 1986 level of 350 might just about enable them to deal with the seriously critical cases but that the required level to deal with the demand for a year was 300, no more. A crisis in the hospital has resulted from the fact that only 220 operations could be provided last year.
It was early in January that Professor Ward made these comments. Very soon afterwards there was public confirmation that the situation was serious. There was the case of Martin Weldon of Cork who was sent home from Dublin, his operation having been postponed for the third time. This is a very critically ill child who was thus exposed to the trip up to and down from Dublin and facing unnecessary risks in a very critical condition. The hospital had no capacity to provide him with an operation because of the limits imposed on it by budgetary restraints. There is a limit on the available number of intensive care beds and on the number of operations which may be performed. In this case, three emergency cases arrived at the hospital and his operation had to be postponed.
We in Fine Gael accept the need for efficiency and economy. In our period in Government we adopted a careful and judicious pruning approach to the need for economy in the health services, but because we value the health services it was exactly that — a careful pruning. What has happened here is just the thin end of the wedge. It indicates that the Government's approach to the health services is having widespread consequences, consequences perhaps unseen by the Minister who I know has a commitment to child care and to child services on a personal basis. What has happened in Crumlin has clearly put children's lives at risk and has moved the working of the hospital onto a margin where calculated risks are being taken all the time.
What will happen on a day when nine emergency cases present themselves, with the absolute limit on recruitment of staff, on the provision of extra beds — each intensive care bed requiring five nurses to staff it — and with the absolute limit on operations? The hospital could not deal with such a situation. Because it can only deal with the emergencies, those who are at the top of the waiting list are obviously in a deteriorating medical state and their lives, I have no doubt, are put at risk. How many of those children who are presented as emergency cases have been weeks and months on that waiting list and have jumped to the top simply because they have had a serious attack and need an emergency operation? This is no way to manage these services. I ask the Minister to outline to us here what has been the result of the special and urgent consideration he has given to this area. Has he come up with proposals? Can he assure us tonight that the situation will be dealt with and that children who need these life-saving operations will be given them?
A number of approaches are possible. My solution to this problem would be provision for the funding of sufficient extra operations to allow the most critical cases to be dealt with on a planned basis. This would avoid the incidence of emergency cases from among those who are waiting too long on the list and would help both to reduce the incidence of emergency cases and enable the waiting list to be dealt with in a planned fashion. People would know that within a reasonable length of time necessary operations would be provided for their children. I believe that last year the Minister committed himself also to a review of the situation. The recommendation of that review by the Department was that operations and service would be restored to the 1986 level. This would mean that in the region of 260 operations would be provided. The Department, it seems, recommended this to the Minister and this recommendation has been with the Minister for some time. However, he has taken no action on foot of that because we reach 1988 with the already critical situation even worsened. Surgeons who have been told of this report by the Department have never seen it. They believe that the situation with regard to the waiting list for paediatric surgery is at a point where they are failing to catch up because emergency operations are going to the top of the list. Had there been, in response to that report of 1986, a restoring last year of the service to the 1986 level, the present critical situation could have been avoided.
I ask anybody to draw a comparison with the British situation. It is hard to avoid doing this when we have had similar cases hitting the headlines in recent months in Thatcherite Britain. Again, children have been sent home from hospitals without operations and there was the tragic case of a child dying postoperatively. Whether that child would have died had his operation been performed in time is something about which people will debate. It is tragic and totally unacceptable here in Ireland that we should expose our citizens to such conditions, those who are innocent of the economic excesses which brought us to the present problems. These patients are totally vulnerable and totally dependent on us to give them a certain priority. The Irish people have spoken out clearly on the value they place on life. We, as a country, spend in the region of £4 or £5 million on a pro-life amendment which amended our Constitution to ensure protection for the life of the unborn. There is a cruel and bitter irony about the fact that we now have to consider, however urgently and specially, whether we will spend £5,000 per life saving operation, because it has been assessed that that is the cost of a single operation.
Crumlin children's hospital has been the first to respond to the demands of the Department that hospitals should develop unit budgeting costs for clinical operations, and the cost indicated for open heart surgery can be quantified. The figure I have heard quoted is in the order of £5,000 per operation. This is indeed expensive if one multiplies that amount by 50, the level of increase we are talking about. But I do not think the Minister has any mandate to do anything other than find that money and resolve that situation because this country has spoken loudly and clearly about the priority to be put on children's lives.
I am anxious to be reasonable and rational in what I say. It is not an openended problem. There is a quantifiable need per year for operations, and hence a quantifiable amount of money that needs to be provided. However the Minister does it, I hope he will indicate tonight that he has found a way of doing this, that he will make a provision, specifically that he will fund sufficient extra operations to allow, the most critical cases to be dealt with on a planned basis and provide the funding immediately and urgently, because if, tomorrow, nine emergency cases presented, there would be no way in which the hospital could deal with them. The capacity to respond by specially sanctioned overtime for emergency situations, sanctioned operating time and sanctioned nursing care for intensive care beds would ensure that we would have a proper service for those who need these vital life saving operations so that these people could rest in some peace without the additional trauma over and above the medical problem they have to deal with all their lives. The additional trauma of going into hospital and coming out again, of being built up for operations and being let down again, the exposure to risks of infection and being in a less fit condition for the operation when it finally comes, could be avoided. It is clear that this situation has deteriorated to the point that senior medical people in the field have, in the light of the cutbacks of the last two years, expressed publicly their concern about the deteriorating situation and about their own ability to cope with it. It demands an immediate and positive response and that is why I have sought to raise it constantly. I have raised it because of the inadequacy of the replies which four Deputies in this House have received from the Minister when he was last before this House at Question Time on 9 February ending up with a commitment which has been repeated ever since that special and urgent consideration is being given to the problem. This is totally inadequate and I hope that here tonight the Minister will be able to expand on this and indicate that he has found a way to deal with this critical situation and outline it to us here tonight.
First, I wish to thank Deputy Flaherty for raising this very important matter in the House tonight.
Our Lady's Hospital for Sick Children has established an international reputation in the field of cardiac surgery for children. The hospital has been in the forefront of medical advances in this field. The number of cardiac operations carried out at the hospital has increased steadily, from 39 in 1974 when the cardiac unit first opened to 256 in 1986. A recent study by Professor O'Conor Ward of results at Our Lady's over a five year period found that survival rates for a number of cardiac procedures were higher than British rates. The hospital has been particularly successful in reducing mortality from congenital heart disease in the very young.
At the end of the sixties, mortality from this disease was 40 per cent. Today, it is only 14 per cent. These figures not only represent a major medical advance, they also represent an unquantifiable reduction in parental anguish and heartbreak. Children for whom there was no hope have been given life.
In allocating funds to hospitals, I have been concerned to ensure that essential services were protected as far as possible. In 1987, Our Lady's took measures to live within its allocation of £12.2 million which included a reduction in the amount of theatre time available for cardiac surgery and a temporary reduction in the bed numbers in the intensive care and special care units.
When, during 1987, there was a suggestion that children were not receiving necessary heart operations, I requested the Chief Medical Officer of my Department to examine the situation at Our Lady's and to report to the Minister on his findings. On the basis of his report, the Minister was satisfied that no child who needed a cardiac operation urgently was denied one because of shortage of funds.
While the number of cardiac procedures carried out at the hospital in 1987 was slightly down on the number carried out in 1986, contributory factors included the radiographers and junior hospital doctors disputes. These disputes had a greater impact on elective procedures which could be postponed than on other aspects of the hospital's activity.
The resolution of these disputes and new work practices which have resulted in maximum use being made of intensive and special care beds, will remove problems which were specific to 1987.
Waiting lists are, and always have been, a feature of the health services. They reflect the gap in every health system between the level of resources required to meet need and the ability or willingness of society to fund that level of service. We in Ireland do not differ from other countries in this respect. We do, however, try to keep waiting lists to a minimum. For many elective procedures, such as coronary by-pass surgery in adults, waiting lists are frequently shorter than in other countries. At present there are 231 children awaiting heart surgery at the hospital. This number represents a waiting period of about two years for non-urgent cases. Urgent cases are being operated on with a minimum of delay. Children on the waiting list are regularly reviewed to ensure that no one is at risk. Even if the hospital had unlimited resources for heart surgery, it would still be necessary to maintain a waiting list. Following diagnosis of an operable heart condition, the surgeons may defer the operation until the child has reached an optimum stage of physical development. The dramatic fall in the birth rate in recent years, suggests that the number of children presenting with operable heart conditions will decline in the near future.
It is an unfortunate, but a normal, feature of hospital care, that nobody placed on a waiting list for surgery can be guaranteed surgery on a particular day. A consultant presented with an emergency case, may have to give that patient priority over the patient scheduled for operation on that day. It may be difficult for relatives of a patient, especially parents of a chronically ill child, whose operation has been postponed, to accept this situation. However, I am sure that most responsible parents, while naturally wanting treatment for their child to go ahead without delay, would not wish that treatment to be at the expense of another child's life.
Although Our Lady's Hospital have resolved difficulties which reduced the number of heart operations in 1987 and a decline can be expected in the number of children born with heart defects, I am naturally concerned that any child should have to wait unnecessarily for a heart operation. I have asked my Department to give special and urgent consideration to how the waiting list for heart surgery at Our Lady's can be reduced.
The discussions between the Department and the hospital are continuing. The Deputy can be assured that the suggestions she has made will be borne in mind by the Minister and the Department. Everything possible will be done to bring the 1988 level of output up to that achieved in 1986.
I am sure that Deputies will appreciate that it would require considerable additional resources to reduce the waiting list in this area of high technology. The hospital and my Department will continue to explore all possible ways of easing this problem. In the meantime, I want to reassure Deputies and, most of all, the parents of the children involved, that no child who needs a cardiac operation urgently will be denied treatment because of the shortfall in resources.
I wish to take this opportunity to compliment the specialist staff and their skill and all the staff of Our Lady's Hospital for the excellent work they are carrying out. I appreciate very much the points of view expressed by Deputy Flaherty and others in relation to this area. I want to express the concern of Deputy O'Hanlon, myself and the Department of Health and to say that we will do our utmost to eliminate this serious difficulty. Nevertheless, the Department are limited in the resources available to them at this stage. Our officials are having discussions with Our Lady's Hospital with a view to improving the situation, which I hope will happen in the not too distant future.
Initially, and perhaps up to the Minister's last point, the response was totally unsatisfactory and disappointing. It indicates that no progress has been made. However, in the Minister's final comments he said that discussions are ongoing and that every effort will be made to bring the level of operations up to the 1986 level. Will the Minister undertake to keep myself and other concerned Deputies informed as to the progress being made? I would like the Minister to make one final comment on how his assessment of the situation is so different from that of the people in charge of the units, Professor Ward and the surgeons, Mr. Wood and Mr. Neligan, all of whom have indicated that they are unable to deal adequately with the demands made on them. I accept that there will be waiting lists but they should be dealt with on a reasonable basis and those at the top of the list should be assured of treatment. How does the Minister's assessment of the situation differ so greatly from that of the specialists involved in this area who, as I have said, in a singular way, above any of the other areas of cutbacks, have expressed their concern about the impact of the cutbacks in this specific area?
I assure the Deputy we will do our utmost to keep the House and the Deputy in particular, informed of developments in this area. I want to reassure her and the House that discussions are under way between the Department and the officials of the hospital involved. The question of a difference of opinion is not very relevant because we have responsibility from a funding point of view. The care of children is particularly emotive and, in a sense, perhaps it is highlighted by vested interests who bring attention to particular areas. We are very concerned, as Ministers and parents, about this problem but we have an overall budget to administer and difficulties have arisen as a result of cutbacks throughout the service. In the circumstances we are doing our best to give the best possible service to Our Lady's Hospital in Crumlin.
The Dáil adjourned at 10.25 p.m. until 10.30 a.m. on Wednesday, 24 February 1988.