Vol. 443 No. 3
8 Mr. McGahon asked the Minister for Health the extent of the necessity for patients to receive medical or surgical treatment outside the jurisdiction; the effectiveness of such procedures from a surgical or economic viewpoint; and if he will make a statement on the matter.
95 Mr. McGahon asked the Minister for Health the total number of patients who have received surgical treatment outside the jurisdiction in each year from 1986 to date; and if he will make a statement on the matter.
I propose to take Questions Nos. 8 and 95 together.
The detailed information sought by the Deputy is not routinely collected by my Department, since it does not become involved in every case. Under the terms of the circular governing the referral abroad scheme, the chief executive officer of the referring health board can approve cases without reference to my Department where the total costs involved are less than £10,000.
Figures available to my Department for numbers referred abroad for treatment are as follows: 1986, not available; 1987, 102; 1988, 114; 1989, not available; 1990, 223; 1991, not available; 1992, not available and 1993, 158.
Patients are referred abroad for a wide range of specialised procedures, the most expensive of which would be bone marrow transplants, heart-lung transplants and liver transplants.
In relation to bone marrow transplants, the Deputy will be pleased to learn that additional resources have been provided in recent years to allow upgrading of the Bone Marrow Transplant Unit at Our Lady's Hospital in Crumlin, and work is now well underway on the new Oncology-Haematology-Bone Marrow Transplant Unit at St. James's Hospital. These developments when completed will allow the national centre at the two hospitals to deal with most cases arising here.
On liver transplants, the national centre for adults at St. Vincent's Hospital was fully established last year and has achieved a high success rate. This followed a considerable investment in services and staff training in co-operation with the Liver Unit at Kings College Hospital, London. The children's Liver Unit at Our Lady's Hospital in Crumlin is still under development and additional funds have been allocated this year to enable it to be operational as soon as possible.
Developments such as these will allow Irish patients to be treated nearer to home and avoid serious disruptions associated with travel abroad for such treatment. It must be accepted, however, that it will not be possible to provide the resources and expertise necessary for all of the highly sophisticated procedures for which patients need to be referred abroad and a limited number of such cases will arise annually.
It will be necessary, therefore, to continue to refer patients abroad for treatment in some cases. The position regarding referrals abroad is kept under regular review in my Department and improvements to specialist services will continue to be made as resources permit.
Why are the figures for some years not available? If figures are available for some years, they should be available for all because the one procedure must be used to compile those figures. Are patients from the Cork area, the Southern Health Board, included in those figures and if so will the Minister elaborate on the necessity to send those people outside the jurisdiction for treatment?
I do not know why the comprehensive figures are not available for each year. They are not routinely collected by my Department and there would be a number of referrals under £10,000 with which I would not be familiar. In the timeframe between the tabling of a question and the reply, it is not possible to obtain a full picture but I will endeavour to do that for the Deputy and pass the information to him in due course.
On hip replacement surgery provided for Cork patients last year, I am pleased that every patient transferred to Belfast transferred voluntarily. The scheme has been successful and one that I would not be averse to repeating, although my preference is to provide services within the jurisdiction and as close to the patient's home as possible.
Given that approximately 5,000 women travel to England for terminations of pregnancies every year, will the Minister comment on the likely position if a risk to the woman's life was diagnosed here but an abortion could not be carried out because it is illegal in the State? Would the Department of Health pay for that woman to travel to another jurisdiction to have a termination?
The Deputy is raising a special matter now.
The question relates to travelling abroad for medical services overseas.
I do not intend to venture a legal opinion on what is lawful. The attitude of the Department of Health and the health boards is that where a procedure is needed and recommended by the clinicians and it is lawful, the best decision is made on where it can be carried out.
Is the Minister presuming that the hip replacement operations are included in the 1993 figure of 158, which is relatively low?
It is clear that they are not.
Why are they not included? The question is absolutely clear and the Minister has an obligation to reply to it in terms that cover the information sought. It is disingenuous for the Minister to say that the figures are simply not there. The hip replacement operations are a key factor in this question and the fact that they are not included raises suspicions.
A supplementary question, please.
I want to ask questions about the hip replacement operations——
The Deputy should table the questions.
——and the failure of the Minister to carry out a cost analysis of these operations with regard specifically to the medical and economic viewpoint referred to in the question. Is it not the case that people were selected for those operations who had no medical complications that would have created difficulties due to the travel involved? Is it not the case also that the way the figures worked out eventually, the scheme was more expensive than the Minister had planned?
The question is quite overlong.
The question is overlong because the Minister did not provide the information sought.
It is a luxury we cannot afford at this time.
He waffled and he did not provide the figures sought.
The matter should not lead to argument or to statements being made.
The question asked for numbers, and no more, and the Deputy is being disingenuous in making that point.
That is simply not true. The Minister should read the question.
I am happy to debate the question of the hip replacement operations——
That is another question.
——although if the Deputy wants information on these matters she should table questions. I am pleased that those people received their hip replacement surgery.
I am not interested in whether the Minister is pleased. I want facts and figures. We are tired of the Minister's opinions, we want information.
I am not greatly concerned whether the Deputy agrees or disagrees with my opinions.
That is not relevant.
I am giving her the facts as I see them. I am pleased with the outcome of the procedures. I understand the Deputy's difficulty in this matter because she invariably approaches such questions from a point of view, that is well-known, and she is entitled to that point of view. I do not have a position to defend other than the interest of patients and that is my total concern in this matter. Without exception, all of those who received treatment and hip replacements in Belfast — and I invite the Deputy to visit them in Cork — were delighted with the treatments they received there. They received treatments that would not have been provided otherwise and the people of Cork, and the Southern Health Board, applauded that action. I will not rule out taking any actions necessary to treat people in need. The Deputy is entitled to hold a different view but I am pleased that we could treat people who would otherwise not have had procedures necessary to improve their quality of life.
Do the figures in the Minister's original reply include the number of people who went to Britain for sex change operations? Did those people travel from jurisdictions other than those under the control of the Eastern Health Board which has been somewhat in the limelight of late?
The Deputy's observations are worthy of a separate question.
Does the Minister foresee in the future a repetition of the practice where patients were sent outside the jurisdiction for hip operations? If so, will the cost factor be taken into account?
The economic cost of any decision is taken into account. Most of the views expressed in the House would favour having treatment for people who need it. I am determined to have a cost effective health service. The cost of any procedure is taken into account before a decision is made. I am hopeful that we can provide for the needs of people within this jurisdiction but if there is exceptional need which cannot be met and I have the resources to meet it elsewhere, I would not rule out a similar initiative in the future.
In anticipation of putting down a question, will the Department be in a position to provide the information on numbers? The Minister has left some years blank. Will he give a breakdown of the costs generated for his Department and health boards if I table a question?
It is all hypothetical.
If the Deputy tables a question I will answer it.
I am asking if the Minister will be able to provide the information.
