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Dáil Éireann debate -
Thursday, 3 Nov 1988

Vol. 383 No. 7

Adjournment Debate. - Cataract Operations.

An Leas-Cheann Ccomhairle

Deputy Tom Fitzpatrick has been given permission to raise on the Adjournment the subject matter of Question No. 38 on yesterday's Order Paper dealing with delays in cataract operations.

Question No. 38 on yesterday's Order Paper in my name reads as follows:

To ask the Minister for Health if people requiring cataract operations are experiencing indefinite delays; if his attention has been drawn to the fact that many of these people are living alone; if he has any plans to resolve this problem; and if he will make a statement on the matter.

The Minister for Health replied as follows:

Indefinite delays are not experienced by patients requiring cataract operations. The waiting time for this operation varies from health board to health board. Priority is given to urgent cases. Information regarding the proportion of people awaiting cataract operations who live alone is not readily available but the majority of such patients are elderly. The Working Party Report on Services for the Elderly —The Years Ahead — A Policy for the Elderly has recommended that present arrangements for cataract surgery in the elderly be reviewed to ensure that those requiring treatment receive it in reasonable time and that the service is expanded to deal with increasing numbers of elderly people. I am currently examining the recommendations of the report.

I asked for permission to raise this matter because I was not satisfied with that reply. I regret to have to say that there is an indefinite delay in relation to certain categories for these operations, that is the category dealt with in public wards by a consultant free of charge, in other words, the middle income group.

This matter came to my notice when I was asked to help a patient from County Monaghan, the constituency of the Minister for Health. The patient is not elderly. For this operation he would be classified as one of the younger patients as he is in his late fifties or early sixties. He was seen by a consultant, having been referred to the Eye and Ear Hospital, in August and he was informed that an operation would be necessary. When he did not receive any notification he contacted me. I got in touch with the consultant concerned and learned that I would have to contact the hospital. I did so and I was told that they were booked up until the end of the year. I was told that it would be well into next year before this patient was reached. I regard that as entirely unsatisfactory. The fact that the man is not elderly makes it worse in one way because he would have expected to have good eyesight and it is all the greater hardship to be without it. He lives alone.

The man who contacted me knew that another patient from County Monaghan saw his consultant in Dublin regarding the same operation. He is an elderly man and, having seen the consultant in Dublin, he was called to hospital there about a forthnight later, on a Sunday, and he was discharged the following Friday having had his operation successfully completed. There is a difference. In the latter case the man who was contacted a fortnight after he had seen the consultant had VHI and could pay his way. The other unfortunate man, who is living alone, was stricken earlier than he might have expected with this complaint but, three or four months after seeing his consultant, he has not been called to hospital. It will be well into next year before he knows when he will be attended to. That is deplorable.

When this service is available to some people it is unacceptable that this man should be deprived of it for so long. It is also unacceptable because it creates a very bad climate and considerable unrest. It makes people unhappy and it convinces them that there is one law for the rich and another for the poor and now it is going a step further with one medical service for the poor and another for the rich. That is bad in a country where so many people are trying to overthrow our system of government, some by lawful means and some by unlawful means. It is providing ammunition to overthrow our democratic system which is the best system devised when it is properly worked.

I am very glad that the junior Minister, Deputy Leyden, is here this evening because we all know he is a caring man. A few years ago he kicked up an unholy row in his native County Roscommon because a hospital for the elderly was threatened with closure. He was in here at Question Time at every available opportunity to protest at the failure of the then Minister for Health to provide the necessary services as he saw them and, as I hope, he still sees them. It is also a coincidence that the county concerned is one which I have the honour to represent and in which the Minister for Health resides. In his reply the Minister said there are different waiting times in different health board areas, but for the life of me I cannot understand that. I cannot understand why, because a man lives in the North Eastern Health Board area he should have longer or shorter to wait than the man who lives in the Western Health Board or Southern Health Board area or somewhere else. These operations, or most of them, are done in Dublin. This is a scandal — it is not too strong a phrase — that a man should have to wait less than a fortnight to be diagnosed, get the complaint attended to, get whatever is put into the eye in, be discharged and be in comfort, able to read the deaths in the newspaper and to drive his car which he was not able to do previously because he could pay for it, and the other man is sitting at home moping in the dark not knowing when he is going to be attended to.

I ask the Deputy to exercise his influence. There are two sorts of influence. One is influence properly so called, the other is nuisance value. I do not care which of them he exercises as long as he exercises one of them within his own party and reminds them of what he was sent out to do. I am sure Deputy Terry Leyden did not go down to Roscommon and kick up the row he was kicking up there about the breakdown in the health services and did not come in here and kick up the row he was kicking up here without the benediction and even encouragement of his own Fianna Fáil Party. Indeed, he got a bit of promotion as a result of his activities in his constituency. I am asking him to get to work on his party and his Minister in all seriousness.

I want to repeat that it is unfair that one person should be kept with this very unpleasant complaint, especially for rural people, farmers, who are moping around in the course of their duties in the dark not able to see, for what I call this indefinite period, because I cannot find out what is going to happen, and surely that is indefinite. It is unfair and it is not good for the country. There are things that can wait and there are a couple of things I would say cannot wait. One of them is in order to mention here and the other might not be so much in order. The health services cannot wait. People such as we are talking about cannot wait. Children with malformation of teeth cannot wait, and the by-roads of Ireland cannot wait. I do not think Deputy Leyden would disagree with me on that.

Sorry, the Minister. I am sure the Minister, Deputy Leyden, would not disagree with me on that either about the health services or the roads. The reply given to me yesterday was given in written form because I was not lucky in the draw. I did not come out for an oral reply, therefore, I had to take a written reply.

First I would like to apologise for the inability of the Minister, Deputy O'Hanlon, to attend this Adjournment Debate. I want to express my thanks to Deputy Fitzpatrick for raising this matter.

I cannot complain about that. As a matter of fact he told me he was entrusting it to the Minister of State.

I want to thank Deputy Fitzpatrick for his comments, first, in connection with my situation. Just because one aspires to ministerial office, as you, a Leas-Cheann Comhairle, and Deputy Fitzpatrick know, one does not change one's attitude and still would have the same concern when in Government as one would have in Opposition. However, when you are in Government you have responsibility for raising the funds to pay for the services. That is the only difference.

I have a detailed statement here but I will just give an outline of the position. I am not going to lecture Deputy Fitzpatrick about the financial situation, debt or cost to the health services because he is well aware of the position. He has dealt with a specific problem which is there. He says waiting for any time is a problem, particularly in cataract operations. I have dealt with some cases, so I appreciate what happens.

Let me give the overall scene. We have expenditure of £1.3 billion on health services at the moment and the difficulty is in trying to provide resources for the health services generally. In particular there are inevitably problems in relation to choices between the many competing demands for resources. A decision to allocate additional resources to a particular hospital or service would mean a reduction in some area of the health services. Elective surgery is one area of the health services where demand outstrips supply. While I cannot accept that indefinite delays are experienced by people requiring cataract surgery, a review of the situation around the country indicates that there are waiting lists for these procedures. The number on the waiting lists and the waiting time for this operation vary from health board to health board.

At this stage I would like to add a word of caution in interpreting waiting list data. The numbers on waiting lists are not as important as the time spent on a list. A lengthy but fast moving list is not as big a problem as a small but slow moving or static list. Urgent cases always receive priority treatment. I want to emphasise that the urgent cases are being dealt with as a matter of priority. There is also regular assessment of those on the waiting lists by the consultants involved who take into account each patient's condition and other circumstances in determining that patient's place on the list. Deputy Fitzpatrick pointed out that those living alone particularly are a priority, and I agree.

I do not propose to outline the position concerning cataract operations in each health board area. However, I want to refer to developments concerning the two eye and ear hospitals in Dublin and Cork. My Department's policy in relation to ear and nose treatment and ophthalmic services is that they should be provided at a general hospital. Accordingly, in the rationalisation of hospital services in Dublin it is proposed that the specialities at the Royal Victoria Eye and Ear Hospital be transferred to appropriate general hospital in Dublin and to the Midland Health Board for which the Royal Victoria has been providing ENT and ophthalmic services pending development of facilities for these at Tullamore General Hospital. St. Vincent's Hospital has been proposed as the regional centre for eye services while discussions are ongoing concerning the transfer of ENT services. Ophthalmic services in the Southern Health Board area will transfer from the Eye, Ear and Throat Hospital in Cork to the Cork Regional Hospital from 14 November 1988. A new ophthalmic out-patients' department has been provided at the regional hospital to facilitate the transfer, and capital funds of £250,000 have been approved for equipping the new ophthalmic unit. A fourth post of ophthalmic surgeon for the Southern Health Board area was approved at the September meeting of Comhairle na nOspidéal. I am confident that the new ophthalmic unit together with the additional consultant post will greatly improve ophthalmic services in the Southern Health Board area.

Deputy Fitzpatrick has drawn attention to the fact that many people needing cataract operations may be living alone. I understand that information on the number of people requiring cataract operations who live alone is not collected by hospitals. However, I accept that many people requiring this operation are elderly and, of course, many old people live on their own. The impairment of eyesight in old age is a major cause of immobility and dependency. The removal of cataracts by microsurgery is one of the most effective ways of improving the sight of elderly people.

Last month the Minister was presented with the working party report The Years Ahead — A Policy for the Elderly. This is a very comprehensive report which provides a blueprint for planning services for the elderly in future years. The benefits to the elderly of cataract operations and the cost effectiveness of the operation are referred to in the report. It recommends that the Department should review present arrangements for cataract surgery in the elderly to ensure that those requiring treatment receive it in reasonable time and that the service is expanded to deal with increasing numbers of elderly people. I am currently examining the recommendations of this report and I can assure the Deputy that the arrangements for cataract surgery will be dealt with in the context of discussions with the health board to implement it.

Let me just give an idea of the situation. In the Sligo General Hospital, for instance, there are 62 people on the waiting list with a five to six months delay. The waiting period varies quite considerably from hospital to hospital. There is a much longer wait in the Royal Victoria Eye and Ear Hospital at the moment. Deputy Fitzpatrick's constituents and indeed the Minister's constituents in the Cavan-Monaghan area would be referred mainly to that hospital. This is something I am certainly going to look into as a result of the points made by Deputy Fitzpatrick.

In relation to the variations in waiting lists at different hospitals, in the Western Health Board area there is at least a two year delay at the moment, it is down to five or six months in Sligo General Hospital, and it is about nine months in the Royal Victoria Eye and Ear Hospital. Those figures are unacceptable to the Department but we have to bear in mind also the question of resources and the utilisation of the resources by hospitals. I believe rationalisation and improvement of the services will take place. I will certainly look at the situation in the context of the variance between the different hospitals. The waiting period is longest in the Royal Victoria Eye and Ear Hospital and the point made by Deputy Fitzpatrick is well made. We would all be concerned about any patient waiting for an excessive length of time for a cataract operation. I will discuss this matter with Deputy O'Hanlon and we will take whatever action we feel is necessary, depending upon the availability of resources, to try to alleviate this situation.

I emphasise that patients who require urgent treatment should ensure that this is brought to the attention of the consultants. People living alone — and I have particular cases in mind — require urgent treatment because they are totally immobile without the operation. It has been of tremendous assistance to people. We will look at the situation to see what we can do to improve it.

The Dáil adjourned at 5.25 p.m. until 2.30 p.m. on Tuesday, 8 November 1988.

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