Deputy Mary Flaherty has given me notice of her intention to raise on the Adjournment the announcement by the board of Our Lady's Hospital for Sick Children, Crumlin, that they will cease bone marrow transplants for children forthwith.
Adjournment Debate. - Children's Bone Marrow Transplants.
I thank you for having given me the opportunity of raising this matter on the first day I sought to do so. It is a rare and pleasant experience, particularly as it is such an important issue.
The announcement last week by the board of Our Lady's Hospital for Sick Children, Crumlin, that they can treat two more patients only before ceasing the service entirely means that the impact of the cutbacks in health are being felt now in a way not experienced to date. We have become used to increased waiting lists but the total abolition of a service for children is something unique and indefensible.
I hope the Minister will be able to indicate to the House this evening that he regards the matter as seriously as I do, that he intends to act to ensure that the proposal to cease operations for children entirely here, forcing them to go abroad, will not happen.
The unit now propose to contact the Eastern Health Board to seek support for cases needing treatment abroad, which cases would then be funded by the Eastern Health Board. I gather that the cost of such an operation, usually in England, is in or about the same as that of an operation performed here; the difference may amount to a couple of thousands of pounds. Added to that cost is the personal cost to the family and the child itself, in travelling from this country, the expense of maintenance, often carried by the Eastern Health Board, such children often requiring long periods of preparation for and recuperation after such operations. For example, there is involved a period of immune deficiency during which children have to be kept in hospital for quite some time.
In that context it seems extraordinary that the cost involved will be borne by the health services through a different avenue. The hospitals have no money but there will be money provided by the Eastern Health Board to have the operations performed abroad at approximately the same cost. That appears to me to be a silly set of circumstances. It should be remembered that it is also very serious and difficult for families facing into a traumatic time during the severe illness of a child or children.
The other unit providing a bone marrow transplant service in Dublin is that located at St. James's Hospital which currently deals with adults only, although I gather they are dealing with children other than the very young. At present they have funds to cover 15 transplants only a year, so there is no question of their having any spare capacity. On the basis of their own list they need to perform 30 to 35 transplants annually in order to provide the kind of service required. The children's unit was performing approximately one operation per month. Therefore, it will be seen that there is a huge shortfall and requirement for services abroad if there is to be no expansion in the direct services provided here.
The practice was established under the regime of former Minister for Health, Deputy Desmond, after some controversy, when a clearcut policy was established that, if necessary medical treatment could not be provided here, it would be provided wherever else it was available provided it was deemed to be medically advisable. That entails an ongoing commitment to provide such a service whether at home or abroad.
What has happened in this regard since the Minister gave a commitment to this House some five months ago, indicating that he intended establishing, jointly, St. James's and Our Lady's Hospital for Sick Children in Crumlin as the national bone marrow transplant unit. When questions were raised in this House about the future of Our Lady's Hospital for Sick Children the Minister categorically assured us that both units would be maintained by way of a joint national service. To my knowledge there have been no meetings held in this respect since February last. In the meantime the hospital have had no funding arrangements agreed or allocations to the joint national service. Therefore, it is not surprising that this crisis has arisen. Let us hope that it may lead to a resolution of the problem.
I am interested to know what the Minister proposes doing. There is no economic argument in favour of what is happening. I wonder who is running the service. If the Minister cannot ensure that commitments he gives are honoured then he should not enter into such commitments or assure us that such a national service will be provided. If the Minister does not have control over the hospitals and health boards, what does he propose to do about it in order to make any progress in regard to the unit budgeting issue. At least if we had unit budgeting, with hospitals being allocated sums, then at least the Department would be able to establish priorities. This would mean that priority areas such as this — and that in relation to heart transplants and operations for children and adults — could be afforded due priority within the politics that obtain within hospitals in which different specialists all vie for a limited source of funding.
The Minister has a particular responsibility to respond, first, because he has given a certain commitment to the House and, second, because of the downstream effect of the overall cut to the relevant hospital — which has provided the necessary funds from within its own resources in recent years. In addition I should say that both this unit and that at St. James's Hospital have been backed and developed to an extraordinary degree by private funding and support. Indeed the operations currently performed at St. James's Hospital are funded, to a substantial degree, by way of private fund-raising; certainly that is the case in regard to equipment there, although the Department did provide some resources at given stages.
I want to know what the Minister proposes to do in relation to this. Will he ensure that there will be a bone marrow transplant service available to children, so that a service which was built up with great effort and commitment on the part of many dedicated people, people who have developed an expertise ensuring that life-saving operations are available to children here, does not cease. I hope the Minister will assure the House this evening that he intends to act to prevent this cessation occurring. As it is quite clear that, if necessary, the funds will be provided by the Eastern Health Board for such operations can they not be directed into the mainline service?
I should say that I carry no brief for any individual hospital. I know there is much politics obtaining within the hospitals services. I am concerned that a service is provided for children, that it is maintained where it is located, be that at two separate centres or in a single one. I am not interested in entering into such argument. I merely want to ensure that a service is provided and maintained for children.
There is no crisis. I should like to assure Deputy Flaherty that bone marrow transplants will continue at Our Lady's Hospital for Sick Children, Crumlin. Officials of my Department along with representatives of Our Lady's Hospital for Sick Children and St. James's Hospital are examining the financial implications of a bone marrow transplant service to ensure that sufficient resources are available. Our Lady's Hospital for Sick Children have carried out approximately 30 bone marrow transplants at a cost of £17,000 each from within its allocation. There is no doubt about the effectiveness of the bone marrow transplant programme. My Department are committed to providing the service in this country rather than sending patients abroad.
Some time ago I initiated discussions between Our Lady's Hospital for Sick Children, Crumlin, St. James's Hospital and St. Luke's Hospital with a view to the establishment of a national bone marrow transplant service. I am glad to say that it is now accepted that a national bone marrow service will be provided in two units, at Crumlin hospital for children and at St. James's Hospital for adults. I can assure Deputy Flaherty that bone marrow transplants will continue at Our Lady's Hospital in Crumlin.
Can the Minister indicate why there is such a dichotomy between his understanding of the situation and that of the board of management of the hospital who have publicly announced in medical journals and to the public that there would be funds for two more operations only? Is the Minister making extra funds available or has something happened to change that situation?
As I have already explained to the Deputy, officials of my Department and representatives from Our Lady's Hospital and St. James's Hospital are examining the financial implications of the bone marrow transplant service to ensure that sufficient resources are available.
The Dáil adjourned at 8.40 p.m. until 10.30 a.m. on Thursday, 5 May 1988.