Dáil Éireann debate -
Tuesday, 19 Oct 1993

Adjournment Debate. - Hip Replacement Operations.

Mr. Allen

I thank you, Sir, for allowing me raise this matter tonight. At present more than 300 people, mainly elderly, are awaiting hip operations in Cork city and county and in Kerry. Approximately 2,000 people are waiting for orthopaedic outpatient appointments, which can mean a wait of up to four years.

In an attempt to deal with the position the Department of Health and the Minister allocated £2 million to the Southern Health Board to tackle waiting lists. That health board was unable to recruit temporary surgeons to deal with the backlog and the problem was compounded by the fact that the four orthopaedic surgeons in the Cork area, who are employees of the Southern Health Board and are paid by the board, refused to increase their workload. The Southern Health Board had two choices. They could either not avail of the Minister's allocation or subcontract the work, which I proposed they should do. They wisely decided on the latter option and the majority of people awaiting operations, despite reservations about travelling by helicopter to Belfast, are delighted that the end of their painful wait is in sight.

The weekend before last a determined telephone campaign was launched to discredit and undermine the health board initiative. I received seven telephone calls all in respect of the same theme, that the Royal Victoria Hospital, Belfast, was not equipped to carry out hip operations, substandard implants were being used, after care facilities were inadequate and Cork doctors on the return of the patients from Belfast would not deal with the patients. This was a reflection on the quality of care in Cork, which I do not accept. I have every confidence in the ability of doctors in Cork, other than the orthopaedic surgeons.

The Irish Hospitals Consultants' Association through its spokesperson has carried out a campaign of misinformation alleging ineptitude on the part of the Southern Health Board management. I have been a critic of the Southern Health Board management in the past when it was justified, but on this issue it has shown foresight, courage and determination in helping the elderly and the sick and carrying out the wishes of the Minister. Allegations that the Southern Health Board was inept in relation to the appointment of the fifth orthopaedic surgeon and the installation of the clean air theatres must be rejected. The Minister will agree that the delay was in the Department and the two decisions were made in the latter part of this year.

The real reason there is such a furore in regard to this matter is that those consultant orthopaedic surgeons employed by the Southern Health Board are also working in private hospitals in the Cork area, the Bon Secours Hospital and Shanakiel Hospital. They have a vested interest in having long public waiting lists because the longer the public waiting list, the greater the demand for their private practice. They are greedy men who are putting their selfish financial wellbeing before the health of their patients. I know of people who are 80 years of age waiting for surgery at present. Those consultant surgeons wish to continue to manipulate the present system for their personal financial gain. Because the Southern Health Board initiative will undermine their lucrative set up, they are attempting to undermine it. What they are doing is possible under the common contract. The present position in an orthopaedic hospital is that, in a 34-bed ward there are 17 patients, in another 34-bed unit there are 11 patients and in a 27-bed unit there are 14 patients. The hospital has the beds and the equipment, but the goodwill and determination of the orthopaedic surgeons is lacking.

I call on the Minister to investigate immediately why there are vacant orthopaedic beds in Cork when the equipment is available and why the surgeons employed in the Southern Health Board will not increase their workload. I appeal to the Minister to review the common contract because it is giving those people the liberty to do what they like. They can mix their private practice with their other work. Their public performance, the work they are paid to do, is suffering as a result, as is the patient.

Minister for Health (Mr. Howlin)

I thank Deputy Allen for affording me the opportunity of addressing this very important issue. At the outset I would like to outline the background to the board's decision to make arrangements with the Royal Victoria Hospital for the provision of hip replacement surgery.

Earlier this year, I launched a major action programme on hospital in-patient waiting lists. Under this initiative, £20 million is being provided in 1993 to reduce waiting lists where there are long waiting times for admission to hospital. In all, the programme allows for the provision of 17,254 additional procedures nationally this year.

The Southern Health Board received a waiting list fund allocation of £1,736,500 in respect of 1,370 additional cases. With the exception of the 300 hip operations at St. Mary's Hospital, Gurranebraher, the health board has indicated that the other 1,070 additional operations for which it has contracted will be met locally.

Delays in implementing the initiative in respect of the 300 hip replacements at the Cork Regional Hospital group were due to difficulties in recruiting a locum consultant orthopaedic surgeon. Despite extensive advertising, no suitable locum could be found. In this regard, the Deputy will be aware that, in August last, I approved the filling of a fifth orthopaedic surgeon post in Cork on a permanent basis. In the normal course, it would take a number of months to have a post filled on a permanent basis, but in the meantime, the health board has, without success, been making exhaustive efforts to fill the post on a locum basis. With regard to orthopaedic facilities generally, the Deputy will also be aware that approval was given to the Southern Health Board in 1992 to provide new clean air theatres at St. Mary's Orthopaedic Hospital, Gurranebraher. Building work, I understand, is due to begin within the next few weeks.

The central feature of the waiting list initiative is that the agreed additional activity targets are achieved. I have stated that where it is clear that targets cannot be met in 1993, for whatever reason, funding will be redirected to other agencies. It was a purpose of the waiting list initiative, which was agreed in the Programme for a Partnership Government that the suffering of those on long waiting lists should be alleviated as quickly as possible.

Finding itself unable to meet the agreed target and mindful of its responsibilities to patients, the Southern Health Board took steps to ensure that 300 patients awaiting hip replacements should not have their suffering prolonged and should not be denied the opportunity provided by the waiting list initiative.

Before entering into a contract with the Royal Victoria Hospital to carry out 300 hip operations over the coming months, I am aware that the Southern Health Board approached all other suitable public and private hospitals in the country but these hospitals were unable to carry out the work in line with the health board's requirements in terms of timeframe and cost.

The health board took the very responsible step of looking further afield in its efforts to help these patients. Surely anyone interested in patient care would applaud them for their efforts. I would like to stress that the option of having the operation carried out in the Royal Victoria Hospital is entirely voluntary, and one for each individual patient concerned. I would also like to stress that the health board has satisfied itself as to the expertise, facilities and quality of care at the Royal Victoria Hospital.

I would like to confirm my support for the speedy and effective action taken by the Southern Health Board in tackling the lengthy public waiting lists for hip operations and I would like to put on record my congratulations to the members of the board, including the Deputy opposite, for their unanimous support for this worthy project.

I am at a loss to understand the constant criticism and apparent undermining by the Irish Hospital Consultants Association, IHCA, of the action taken by the Southern Health Board to ensure speedy relief to a large number of patients who would have been in pain and discomfort for an unacceptable period of time.

I do not think it would be unreasonable to expect a responsible representative medical body to fully support all action taken in ensuring that the target of over 17,000 additional procedures to be carried out in 1993 with the special allocation of £20 million for the national waiting list initiative is met.

The indications at present are that this target will be met bringing enormous benefits to thousands of patients and their families throughout the country.

I wish to inform the Deputy and the House that I am determined to achieve the maximum amount of good with the resources available to me. I will not be deflected by any individual or interest group from achieving this objective.