Vol. 417 No. 7
9 Mr. Kavanagh asked the Minister for Health if he will give details of the present waiting list period for major cardiac surgery in public hospitals in the Dublin area and the equivalent period for each of the last five years for which figures are available; and if he will make a statement on the trend indicated and on the matter in general.
62 Mr. Gregory asked the Minister for Health if he will outline the number on the waiting list for heart by-pass operations at the Mater Hospital, Dublin 8; and if he will make a statement on the matter.
I propose to take Questions Nos. 9 and 62 together.
Heart surgery for public patients is performed in three locations — the National Cardiac Unit, Mater Misericordiae Hospital, Dublin; Our Lady's Hospital for Sick Children, Crumlin, and Cork Regional Hospital.
There is a total of 1,113 adults on the waiting list for cardiac surgery, 1,068 of whom are on the Mater Hospital waiting list. There are 47 paediatric cases on the Crumlin waiting list.
The admission of a patient to hospital for cardiac surgery is a clinical decision taken by the consultant concerned and is based on the patient's condition and not on the length of time on the waiting list. I think the Deputy will understand this. Emergency cases are dealt with immediately. However, the number of emergency cases arising will obviously affect the waiting times for non-emergency admissions. This has been the admissions procedure over a number of years.
Significant additional resources have been allocated to cardiac surgery over the last two years, in spite of severe financial restrictions. Special additional funding was approved for the provision of ten additional cardiac beds at the national cardiac unit. The total capital cost was £421,000, made up of £235,000 for renovation and upgrading works and £186,000 for equipment. Furthermore, £400,000 additional annual staffing costs were approved which is, of course, a cost which must be provided on an ongoing basis each year.
A second post of cardiac surgeon has been sanctioned in Cork and it is hoped that this post will be filled by the end of 1992. This appointment will double the cardiac surgery output at the Regional Hospital in Cork.
The Deputy will be pleased to learn that as an immediate step in expanding services this year I have allocated £120,000, for the provision of 40 additional open heart operations at the Mater Hospital in the current year.
The Minister did not give details of the number of people who have been on the waiting list for major cardiac surgery for the past five years. Would he not agree that there has been a 12 per cent increase in the waiting lists for cardiac surgery over the past nine months and that this problem cannot be resolved by carrying out the 40 extra operations to which he referred unless, as the Minister suggests many of these operations are unnecessary. Can he indicate how he is going to tackle this problem?
I wish to point out to the Deputy that open heart by-pass surgery is a relatively new procedure. My concern is that there will be such a demand for this service, it will gobble up all the health budget and that the mentally handicapped people with mental illness and the elderly will be relegated to the bottom of the list. As I said, when one creates a service one creates a demand. Every country in the civilised world has found that the only way costs can be curtailed in the health services — it is a bottomless pit — is to have waiting lists. Unfortunately the more successful an operation, the greater the demand for it and, consequently the longer the waiting list. It is not so very long ago that we did not have such operations. Nowadays practically everyone I meet has a CABG, as it is called. They have all had coronary artery by-pass operations. It has become very fashionable. Waiting lists are a measure of the success and advances in technology and medicine. People who do not recognise this fact are blinding themselves to the reality of the health service. As I said when I was a backbencher, we need to have a national debate on this issue. The demand for the service is now so great that I am afraid it will gobble up all the health budget. I ask Deputies to bear this in mind.
The Minister has said that this operation, which has become very popular and very expensive, does not prolong one's life but, does it not save life?
The condition is not life threatening; it is just cardiac, or chest pain which can also be treated by way of tablets — they have the same effect. A person's life cannot be lengthened by an operation any more than it can be lengthened by taking the tablets prescribed for the condition. People need to bear this in mind. I would defy any consultant-cardiologist to contradict what I am saying. An operation may improve the quality of life but the same result can be achieved with tablets.
People who are crippled by cardiac pain, so to speak, should undergo the surgery. As I said, hospitals should set up monitoring review committees. GPs should also be encouraged to categorise their patients. Not everyone on the waiting list may need an operation. The Deputy might find what I am saying amusing but that is the harsh reality. We have to look sensibly at this issue. There will no doubt be more major advances in the area of technology. Kidney transplants cost £20,000 and a large number of these operations are carried out every year. Advances in his area are taking place at a phenomenal pace. Tests carried out on a machine installed in one Dublin hospital cost £600 each. These advances in technology and medicine are placing an enormous strain on our health services.
That disposes of questions for today.
