Vol. 459 No. 3
22 Kathleen Lynch asked the Minister for Health the number of patients referred for diagnosis or treatment outside the State in cases where appropriate facilities are available in the State but where waiting times are excessive; and if he will make a statement on the matter. [18159/95]
(Limerick East): There is a number of situations where, for operational reasons, health boards make arrangements for treatment to be provided outside the State. In particular, the North-Western Health Board and the North-Eastern Health Board have developed such arrangements with the Northern Ireland health authorities.
In my opinion, such links with the Northern Ireland health authorities represent a sensible approach to the efficient use of scarce health resources. As part of on-going discussions with the Northern Ireland authorities we will be looking at ways in which such arrangements can be developed for the benefit of patients, North and South.
I tabled this question to discover how extensive is the co-operation among the various health boards. I presume that obtaining such information would require tabling a different question. However, I hope that the Minister might provide some information along those lines. How many people have been referred to health areas outside the State due to the excessive length of waiting lists? What type of cases have been referred?
(Limerick East): Such referrals have taken place on a small scale. In terms of ophthalmology and ENT services, a number of patients have been referred from the North-Western Health Board and the North Eastern Health Board for attention in Northern Ireland. The Deputy will be aware that patients from County Cork were sent for orthopaedic treatment to Belfast as part of the waiting list initiative.
Many Deputies have brought to my attention the fact that quite a large waiting list exists for people awaiting cardiac surgery. I am currently engaged in negotiations with service providers, here and in Belfast, in an attempt to shorten that waiting list before the end of this year. If I am satisfied with that agreement, in terms of quality and price, it will represent another initiative undertaken by my Department. The service will not be provided exclusively outside the State in Northern Ireland. Some cardiac facilities in the South with spare capacity will be given the option to compete on the basis of a tendering system. The arrangement is almost in place where a number of hospitals on this part of the island and a hospital in Belfast will participate in reducing waiting lists for cardiac surgery.
I am pleased with the Minister's reply. I believe it represents a very sensible approach to a very expensive and intensive health area. Now that the straitjacket has been removed in relation to treatment outside the State, particularly with regard to cardiac surgery — the waiting list for which is quite long, sometimes too long for those seeking treatment — does the Minister intend to consider the area of experimental treatment outside the State? Such treatment is not available within the State and is sometimes unorthodox. Nevertheless, people in desperate situations are quite prepared to try it. Is the Minister prepared to consider such treatment? In the past, the answer was firmly negative because such treatment was unorthodox, unavailable within the State and considered not to be of benefit to the individual patient involved. I am glad to see that the Department's position has changed in relation to other treatment outside the State. Will the Minister make a statement in relation to experimental treatment?
(Limerick East): Deputy O'Donnell will be receiving a written reply today to a question she tabled regarding the public cardiac surgery waiting list and the use of facilities in Belfast and in public and private hospitals in Dublin. I refer Deputies to that reply because, having tabled the question, Deputy O'Donnell is entitled to receive the information first. The policy is that services in the State should be geared to meet our needs. This initiative will not be a permanent feature of cardiac surgery; it is simply aimed at reducing waiting lists while facilities here are prepared.
With regard to the second issue raised by Deputy Lynch, the Deputy is moving into a different area. Deputies will be aware that where a particular treatment is not available within the State, health boards will — under certain circumstances — fund patients to avail of it outside the State. Sometimes if treatment is not available within the State, it tends to be new or experimental. If it were routine it would be available here. The health boards have the discretion to decide on grant-aiding patients up to a level of £10,000. If the financial requirement is greater than that figure, the case goes to the Department of Health for sanction. That is totally different from the Department of Health buying items of service or for instance four hundred cardiac interventions from a hospital in Belfast. It is a totally different scheme but I can provide the full guidelines to the second scheme mentioned by the Deputy. However, the principles of it are as I have outlined.
I would appreciate that information because whereas it does not affect a wide range of people it has an enormous effect on the individuals seeking that type of treatment. Does the Minister envisage that negotiations in that regard between the health boards and the Northern Ireland authorities will be completed by the end of this year or early in the new year? That is of great concern to many people on waiting lists for cardiac surgery.
(Limerick East): The facilities are available at present at the national cardiac surgery unit of the Mater Hospital, Cork University Hospital and the Blackrock Clinic. There is spare capacity in these hospitals and we are in negotiations on funding to reduce the waiting lists. We are also in discussions with people in Belfast, and as I understand it, an agreement is imminent.
I have no fundamental objection to having certain services provided outside the State — the programme of hip operations, which was very successful, was a case in point. I trust the Minister does not intend that availability of services outside the State will be used as a device to delay appointments which would enable surgical operations to be carried out within the State? While availability of the service in the North would serve patients in critical need of surgery, it would present enormous hardship to the families of cardiac surgery patients, who wish to be near their relatives when they are critically ill. When will the Minister appoint the new board of Comhairle na nOspidéal which will enable a number of very necessary appointments, including the appointment of an oncologist in Cork? A number of key appointments are outstanding and cannot be made until the new board has been appointed.
The Deputy seems to be going beyond the bounds of this question.
It is related.
(Limerick East): The policy is to gear up the services to match domestic need. The initiative on cardiac surgery involving a facility in Belfast is designed to cut waiting lists. It arose from circumstances where there are some available funds at the end of this year. I thought that was a good way to use them, but it will not be an ongoing scheme. In terms of facilities being available, visits by relatives and so on, patients for surgery will be selected from the northern half of the country, particularly the North-Western Health Board and North-Eastern Health Board areas. The extra capacity in Dublin will be used for other areas. This is a once-off initiative and will not be a routine part of the delivery of services. On the question of Comhairle na nOspidéal, the Deputy's colleague. Deputy Clohessy, has a separate question on that matter. I will appoint the board shortly.
I sneaked in that issue because I thought we might not come to that question.
(Limerick East): There have been no delays in appointments. but the board will be set up shortly.
Will the Minister accept that specialist treatment, which is available to private patients, should be made available under the GMS?
(Limerick East): In general terms I agee with that principle but in terms of cardiac surgery I would not differentiate between public and private.
I agree that is a different issue.
