Austin Deasy
Question:7 Mr. Deasy asked the Minister for Health the average waiting time for a heart by-pass operation in respect of a patient who goes private and public. [4579/95]
Ceisteanna — Questions. Oral Answers. - Heart By-Pass Waiting Lists.
Austin Deasy
Question:49 Mr. Deasy asked the Minister for Health when a person (details supplied) in Waterford who is a medical card holder and was diagnosed to be in need of a heart by-pass operation in October, 1994 will be called for the necessary operation. [4580/95]
(Limerick East): I propose to take Questions Nos. 7 and 49 together.
Admission for open heart surgery in the public hospital service is determined having regard to the medical condition of patients and not on the basis of whether they are classified as public or private patients. Admission is based solely on the patient's condition and not on the length of time on the waiting list. Emergency cases are given priority. In these circumstances, the average waiting time is not a critical indicator of the adequacy of the service available. Nevertheless, the need to provide additional facility for open heart surgery for adults, including by-pass surgery, has been recognised for some time and the following steps have been taken to improve the position.
In 1993, a sum of £1 million from the waiting list fund was allocated to enable the necessary facilities to be put in place at the National Cardiac Surgery Unit, Mater Hospital to increase the annual throughput of open heart surgery at the hospital from 750 to 1,000, an increase of 33 per cent. In addition, in 1993 and 1994 funding of £2.8 million was provided to facilitate the doubling of cardiac surgery at Cork University Hospital from 200 to 400 patients each year.
Over 1993 and 1994, in excess of £2 million revenue and £3.5 million in capital was allocated to the Mater Hospital for cardiac surgery and related developments.The building works associated with this development, were completed in mid-1994. They include additional cardiac maintenance beds, intensive care facilities and high dependency facilities required to support the cardiac surgery programme. These new facilities at the hospital have now become operational and the additional cardiac surgery activity has commenced.
Additional resources of £200,000 are being provided in 1995 to the Mater Hospital to ensure that throughput in cardiac surgery in 1995 reaches the target of 1,000 open heart operations per year.
The developments at the Mater Hospital, together with the developments for cardiac surgery at Cork University Hospital, which were opened in November, 1994 will have the effect of increasing the number of cardiac surgery operations performed on an annual basis in the public hospital sector by 47 per cent from 950 to 1,400.
I have no information on waiting times in the private sector.
The question of the provision of further additional facilities for cardiac surgery will be considered as sympathetically as possible in the context of the many competing demands for resources throughout the health services.
I have written in detail to Deputy Deasy regarding the specific case mentioned and I would draw the Deputy's attention again to the central role of the patient's general practitioner who would be in the best position to highlight the case to the consultant concerned.
I take it there is no waiting period for a particular operation, such as a heart by-pass, which would appear to be the gist of the Minister's answer. Is the Minister saying it is merely a matter for the patient's doctor or relevant consultant to decide whether that patient is sufficiently critical to warrant an operation and that, if not, he or she could be waiting forever?
(Limerick East): It is an area of surgery for which there is very strong demand and in which there is not sufficient capacity to deal with every patient who, in the opinion of his or her doctor, needs treatment. There is no distinction drawn between private and public in public service hospitals. The sorting of the waiting list depends on the priority needs of a patient, ensuring that patients who most need treatment are treated ahead of others whose need is not as acute. There is a list of people in need of surgery, who are requesting surgery and whose doctors are requesting surgery. Progress has been made over the past two years to bring cardiac surgery facilities in line with the demand, in the Mater Hospital in Dublin and at Cork University Hospital.
My Question No. 49 refers specifically to a public patient, to a man with a medical card, who has been awaiting a heart by-pass operation since October last and who has been given no indication if and when he will have one. Obviously he and his family are very concerned about it. What are the realistic hopes of such a person having an operation before becoming so critically ill that his or her health condition would be irretrievable?
(Limerick East): Sometimes the health of a patient on a waiting list deteriorates unexpectedly or more than was expected by his or her general practitioner. In those circumstances the patient's general practitioner resubmits his or her name to the consultant involved on the basis of a changed medical condition and there can be a reordering of priority on that basis. The only advice I can give to people on the waiting list is that if their circumstances have changed they should return to their general practitioners and ask them to approach consultants to prioritise their patients' needs in light of the new information.
As the Minister rightly said there are two public facilities which carry out cardiac surgery, one in Cork and one in the Mater. In the light of extra finances being available, does the Minister have proposals to extend the cardiac surgery facilities at any other location in the country, particularly at UCHG in respect of which proposals have been submitted by the local health board and the private sector?
(Limerick East): A number of suggestions have been made to my Department about the extension of such facilities, but I am not in a position to reply positively to any of them. As I mentioned on the last occasion I replied to Dáil questions, the case being strongly pressed is St. James's Hospital from where cardiac surgeons travel to the Mater Hospital to carry out cardiac surgery. They want a facility at St. James's Hospital. However, when the matter was investigated thoroughly it was found that by maintaining and centralising facilities at the Mater and bringing the surgeons at St. James's to the Mater the throughput was better in terms of the number of people who could be dealt with than if there were two separate facilities. Cardiac surgery is like any other service, there comes a point where there is a better return on the centralisation of facilities. For the sake of having a better geographic spread, I am not prepared to reduce the number of people who can be treated to enable those who are being treated to be cared for nearer home.
Will the Minister agree there is a high demand for cardiac surgery because it is life-enhancing and, for many people, often life-saving surgery?Will the Minister agree that there is great inequality between the private patient who can elect to have a life-enhancing operation and a public patient's access to such surgery?
(Limerick East): I am not sure if that is the reality as I do not have waiting list statistics for hospitals like the Blackrock Clinic to which the Deputy is probably referring.
In the case of private and public patients awaiting heart surgery in the same ward in, say, Beaumont Hospital, invariably the private patient is transferred to the Blackrock Clinic or some other hospital and the public patients is sent home to wait perhaps a year or longer for an operation. Is the Minister aware of the level of concern and the perception among public health patients awaiting heart surgery, that a private patient lying in the next bed will be transferred immediately to the Blackrock Clinic while a public patient will be told to go home and he or she will be called back.
The Deputy should not ask too many questions.
In drawing the distinction between life-saving and life-enhancing surgery it is a deeply held perception among public patients that absolute priority is given by consultants to private patients for life-enhancing heart surgery while there does not appear to be any effort to treat public patients, whose quality of life is deteriorating with equality.
The Deputy has made his point rather effectively.
(Limerick East): I note the Deputies points and it is easy to agree that additional services should be provided for any area of medicine. I am sure that in dealing with later questions Deputies will request that the weighting of resources should be given to other areas. There is a constant demand for additional facilities for the mentally and physically handicapped. I have just dealt with a question in regard to which there were demands from Deputies on both sides that the waiting list for orthodontic treatment should be cut. I will try to allocate resources to areas of greatest need without neglecting areas of lesser need. In doing that in terms of cardiac surgery, I am following the policy of my predecessor and the previous Government because facilities have been improved fairly dramatically. Pre-1994 750 operations were carried out in the Mater Hospital and 200 were carried out in Cork University Hospital. By the end of this year the Mater Hospital will be carrying out 1,000 operations and there will be a doubling of the number of operations in Cork to 400. A total of 1,400 operations will be carried out by the end of this year against 750 operations carried out pre-1994 and I will continue to progress that. I understand the throughput of cardiac patients from the Blackrock Clinic and the Mater Private is 700. Comparing those private facilities to the public facilities, the throughput of cardiac patients at Cork and the Mater General is twice the throughput of the Blackrock Clinic and the Mater Private. There are significant improvements and I am committed to continuing the improvements, but there is always a competing demand for available resources.