Deputy Gilmore gave me a notice of his intention to raise on the Adjournment the long waiting lists of patients awaiting heart by-pass operations, especially the case of a mother of four children. The Deputy has five minutes and the Minister five minutes to reply.
Adjournment Debate. - Heart Surgery Procedures.
I thank you, a Cheann Comhairle, for giving me the opportunity to raise this issue on the Adjournment. Throughout today, we have been dealing with a crisis, the life and death of the present Government, but I should like to deal now with the life and death crisis faced every day by more than 800 patients awaiting heart surgery. I should like to instance one such case, a mother of four children who suffered a heart attack in August 1989. Following an angiogram it was established that she had an 80 per cent blockage and was booked into the Mater Hospital for a triple by-pass operation in July this year. Her problem is that she is at the bottom of the waiting list. She knows she will have to wait two years or thereabouts before her operation can take place. I have made inquiries about the case with the surgeon concerned and with the hospital. The information I have been given is that the only operations now carried out — two per surgeon per week — are on emergency cases only; in other words, people who have already been hospitalised who await heart surgery. Somebody who is at home awaiting heart surgery simply is not being operated on at present. The only way such people can get their operation, quite literally, is in the event of their having another heart attack or becoming so seriously ill they have to be hospitalised and are then treated as an emergency. Quite literally these people, more than 800 patients, live in a form of death row.
I know that the cardiac surgeons and the cardiologists have already brought this matter to the Minister's attention. They have told him that there is dire need, that people on the waiting lists run the risk of suffering a fatal heart attack. Doctor Kieran Daly, a cardiologist at University College Hospital, Galway, has said that two of his patients have already died awaiting surgery. Mr. Maurice Nelligan said it is difficult to quantify the number of deaths which would have been prevented had patients been operated on sooner. He went on to state that it was unacceptable that people should have to wait two or three years when the duration on a normal waiting list should be two or three months.
I understand that the cardiac surgeons had a meeting with the Minister not so long ago to discuss their demand that the number of heart operations on public patients be increased from the current rate of 500 annually to at least 1,000 annually, the level which had existed prior to the health cuts. I understand they were told that the deputy chief medical officer in the Minister's Department was examining the position.
I put it to the Minister that it is unacceptable that people must wait so long for heart surgery, quite literally living with the terror of death. It is the Minister's responsibility to take immediate, emergency action to prevent the loss of life of patients awaiting heart surgery and to do so now before anybody loses their life simply because they cannot be operated on in time.
All countries are experiencing difficulty in meeting demands for high technology medicine and surgery; that is recognised. Indeed, in relation to heart by-pass operations, we undertake one and a half times more procedures per thousand patients than are undertaken in England and Wales, therefore, in terms of the numbers of operations being performed, our figure is higher than that obtaining across the water. I suppose to an extent it is fair to say we are the victims of our own success in that, for example, since I assumed office, we installed £10 million worth of equipment at St. James's Hospital. The cardiac investigative equipment there is the most modern of its kind worldwide. Because that type of high technology investigation is available, more people are finding their way on to the waiting lists for heart surgery. Indeed the same applies in Galway where there is new investigative equipment they did not have before and people there are finding their way on to the waiting lists also.
I appreciate the points Deputy Gilmore raised about Dr. Daly in Galway and Mr. Nelligan. I think Mr. Nelligan is more honest than Dr. Daly when he says it is difficult to quantify which patients may be at risk on a waiting list whereas Dr. Daly stated categorically that two patients died as a result of not having had surgery. Patients may be on a waiting list only a week and they may die; also patients not on the waiting list, unfortunately, die and this is very difficult to quantify. We would be fooling ourselves if we thought we could eliminate waiting lists altogether since no country has managed to do so.
Why are there fewer operations?
The reason fewer operations are taking place is that in January of this year we gave the Mater Hospital exactly the same allocation as we had the previous year to perform 750 operations. When they were given their allocation the unilateral decision of the surgeons was that they would hold patients in hospitals for a longer period. I do not fault that decision which was a clinical one. They then decided that, in order to do so, they would reduce the number of procedure to 500. That was their decision, not ours; we had funded them for 750 procedures. They did not come and tell me that at that stage. They came to me at a later stage. We addressed the issue. We decided we would put new beds in place so that they could bring the number back up to 750. We allocated them the money to do that. They put their planning in place and they commenced the renovation of the necessary area of the hospital to provide more beds. As far as we are concerned, we did our bit to ensure that they could come back up to accommodating 750 cases annually. It was entirely a decision of the cardiac surgeons.
But people have died.
The money was provided by my department for 750 procedures this year. The chief medical officer of my Department has investigated the position. I will be meeting the Irish Cardiac Society, comprised of the physicians involved in assessing patients for cardiac surgery, in the near future. Within the next couple of months it would be our hope to improve the position considerably — apart altogether from what has happened in the Mater Hospital — bringing the number back up to 750 procedures. It is important that the House realise that the Mater Hospital is not the only hospital in Ireland where cardiac open heart surgery is performed. It is performed also at the Cork Regional Hospital where a certain number are undertaken.
On the question of the patient raised by Deputy Gilmore, the place on the list and when an operation is performed is entirely a matter for the clinician; it is not a matter for us. I want to ensure that when we have a waiting list, because there will always be waiting lists unfortunately, they are at a level we can control. I want to ensure people can get treatment when they need it. That is what we are doing.