I will not welcome the Minister of State, Deputy Power, to the House, since he has already had a long evening here.
Adjournment Matters.
Hospital Services.
I am very fond of the Seanad.
I have tabled this important matter on the Adjournment to seek clarification of the current status of co-operation between Belfast and Donegal regarding facilitation of cancer patients. I ask not as a matter of concern but for clarification, since the relationship is evolving. I acknowledge the good work that has been done to date and the negotiating team that has set up the facility in Belfast to give people in Donegal the choice between there and Galway.
I also seek clarification of the arrangements regarding the different levels of cancer treatment and who is being facilitated. Are all patients being given the choice, or is there a select group? As I stated, co-operation between Belfast and Donegal is evolving, but ultimately we must keep the Donegal public well informed. I have anecdotal evidence which suggests that a patient in Donegal was not being facilitated in Belfast within the past few days, and that is what caused me sufficient alarm to table this matter. However, it may have been the case that the proper mechanics had not been set up between Belfast and Donegal.
In a general sense, I initially welcomed this co-operation, as I would any in an all-Ulster context. However, it is most important that the people of Donegal and the north west be assured that this will not be a long-term solution. Galway and Belfast are still peripheral to the north-west region, and it is politically very important that the pressure be maintained to ensure a satellite radiation facility is established in the north west in the medium to long term. There is still significant demand among the people of the region for their own local services. A critical point in that regard is that we do not want services to be provided willy-nilly all over the place for their own sake. However, the people of the north west want a fair share of the pie and a transformation from the present situation whereby patients must spend hours travelling long distances to access basic essential services.
With respect to the more local dimension to medical services in the north west, in the past few days there has been an extremely serious blockage regarding general services at Letterkenny General Hospital. I ask that the Minister of State use his influence to expedite construction of the new wing and admissions unit there. We will have new modular facilities in January, but we must keep a very sharp focus on the short to medium term.
I welcome the opportunity to speak on this issue and am seeking, first, clarification regarding the systems that will be employed and who will be allowed to use facilities in Belfast. Second, it is important to recall that the Minister stated in this House that Donegal patients will be facilitated in Belfast only after priority patients from the North have been cared for. That means that it is not a first-class, transparent system for the people of the north west. While we welcome it and congratulate those involved in fast-tracking it as part of the negotiating team, one must remember that there is not equal access for the people of Donegal. It is not an all-Ulster initiative or a primary accessible treatment facility for the people of Donegal. The only way to get around this problem is by the setting up of a standalone radiation treatment centre for the north west in the long term. We must keep a sharp focus on that objective.
I thank Senator McHugh for raising this matter on the Adjournment. I hope that I will be able to provide the clarification that he sought. If further information is required, I will do my best to get it for him.
Acute hospital services for Donegal are provided at the general hospitals in Letterkenny and Sligo. Donegal residents who were referred for radiotherapy services previously had to travel to Dublin.
In July 2005, the Government decided that the best option for improving geographic access to radiation oncology services for patients in the north west was to facilitate access to Belfast City Hospital, BCH, in the short term. Last autumn, the Minister agreed with the then Minister for Health in Northern Ireland, Mr. Sean Woodward MP, that the radiation oncology centre at BCH would provide treatment to patients from Donegal. A project board was established under the aegis of Co-operation and Working Together, CAWT, to deliver on the ministerial commitment. It includes representatives from BCH, Altnagelvin hospital, Letterkenny hospital, the Health Service Executive and the two Departments.
I am pleased to inform the House that a service level agreement has been reached for the referral of about 50 radiation oncology patients annually from Donegal to BCH. It has also been agreed that the number will be increased if there is sufficient demand from patients in Donegal. Patient pathways have been developed, and the Health Service Executive and BCH have agreed the basis for costing the service provided by BCH. Three assessment clinics will be held each month on an ongoing basis. The first referral clinic took place on 8 November and patients are being referred for treatment.
Under the agreement, patients who are considered by the consultant radiation oncologist at Letterkenny General Hospital to require radiotherapy will be offered the choice of being referred to BCH. I am advised that patients in south Donegal receive oncology services at Sligo General Hospital. Those patients will be referred as appropriate for radiation oncology services to University College Hospital, Galway, and St. Luke's Hospital, Dublin.
The service for patients accepted for radiotherapy by BCH will be delivered in accordance with the standards set out in agreed clinical and social care governance guidelines. Patients have the option of choosing the location that suits them best regarding travel time, transport arrangements and other personal or family circumstances. The HSE is also committed to supporting the travel needs of patients in Donegal referred to BCH.
This agreement reflects the significant commitment by the Government to developing North-South co-operation in health. On behalf of the Minister, I acknowledge the work of the hospitals, the CAWT and the respective Departments.
The Government is committed to making the full range of cancer services available and accessible to cancer patients throughout Ireland. There is considerable political, departmental and service commitment to delivering on the agreement. It is important, therefore, that the initiative succeeds, as it will support further co-operation in health care, including cancer care.
It is extremely important that we remain focused on the demands of the people in the north west, and not only those in Donegal. I speak of others straddling the Border, from Tyrone down to Fermanagh and back up to Derry. There is an urgent demand to ensure a north-west satellite radiation treatment centre. I acknowledge that this is a move forward and accept that there has been very positive co-operation between North and South. I also acknowledge that this is more than simply a relationship between the two Departments but something symbolically significant.
The point I wish to make is simple. Prior to the 2002 general election, a commitment was made, in writing, that a north-west satellite radiation treatment system would be put in place. I have been asking for such a service for almost four years but have yet to see any evidence that this commitment will be fulfilled.
Does the Senator have a question?
Yes. Is the Government interested in setting up a satellite radiation service in the north west? It requires only a simple "Yes" or "No" response.
I am sure the service level agreement to which I referred will be very much welcomed by Senator McHugh's constituents. I appreciate his interest in and knowledge of this issue. While we welcome the ongoing co-operation between people in the North and South, it is rather more difficult to achieve the same level of co-operation between politicians. Such co-operation is in its infancy. While we are appreciative of the support and co-operation we have received from Belfast City Hospital, we see such co-operative measures as a short-term expedient. Other solutions are being sought and will be found.
Private Health Care Insurance.
I welcome the Minister of State, Deputy Seán Power. I am interested in his views on competition in the health insurance market and, in particular, on the proposed introduction of risk equalisation. If the latter is implemented as proposed, it may well result in the health insurance market returning to a state of total monopoly by one provider.
The Irish health insurance market is unique among European and international models in its domination by one major player. VHI has a near monopoly on the market and had it entirely to itself for almost half a century. BUPA, a relatively new company, and VIVAS, an even newer one, have a limited share of the market between them but may now be obliged to operate according to the constraints of risk equalisation. A decision in the courts last week means that the Government is entitled from a legislative prospective to introduce risk equalisation. Interestingly, the judgment in this case included an observation that risk equalisation, if implemented as currently proposed, could make BUPA's position in the market commercially non-viable.
Given that the State encourages people to avail of private health care insurance, it has an obligation to ensure there is maximum competition in the market. Whether in respect of air or bus transport or any other form of economic activity, the one lesson we have learned beyond doubt in the last 20 years is that competition works and that a deficiency in this regard has negative consequences for consumers. It must be a keystone of health insurance policy to ensure that competition remains in the market. Not only must BUPA and VIVAS be facilitated to remain in the market but other players must be encouraged to offer health services to the public.
There is a convincing body of evidence to support my contention that the concept of risk equalisation, as threatened to be enacted by the Government, will result in the collapse not only of one particular company but of competition in general in the health insurance market. What will the Minister for State do to ensure competition is protected? What will be done to cushion the blow from the introduction of risk equalisation and the subsequent driving out of competition in the market?
I understand a meeting took place last night between the Minister for Health and Children, Deputy Harney, and representatives of BUPA, but I am not aware what transpired. Media reports at the weekend suggested the Minister is considering the introduction of several measures to deal with the greatly unbalanced situation of VHI's strength in the market. There were even suggestions that VHI might be broken down into several companies. These and other issues must be addressed in the interests of protecting competition.
There was an unwillingness on the part of some in the body politic to accept that risk equalisation might drive out BUPA and other health insurance providers. It has dawned on many in recent days, however, particularly in view of last week's court judgment, that risk equalisation, if introduced as proposed, will do just that. BUPA, a mutual society rather than a profit-making company, will be driven out of the market, and other companies will be discouraged from entering it.
Rather than facilitating a monopoly situation, we must ensure there is competition. Risk equalisation, however, is the greatest threat to competition. Its introduction in the context of the already distorted health insurance market in this State must be urgently reviewed and reversed. I look forward to the engagement of the Minister of State and the Minister, Deputy Harney, on this issue in the next crucial weeks. I await the Minister of State's response with interest.
I am responding to this Adjournment matter on behalf of the Minister for Health and Children, Deputy Harney. Private voluntary health insurance is an integral part of the Irish health care system, a service of which more than half the population avails. It has, for almost 50 years, played a major role in the financing of our health services and in offering choice to the public. There is widespread support for Government policy establishing community rating as a fundamental principle of the health insurance market. This principle, together with lifetime cover and open enrolment, guarantees affordability of private health insurance for many people and an equitable non-discriminatory regulatory framework for health insurance.
The Government continues to support sustainable competition and consumer choice in the private health insurance market. Alongside this, the Government will also support the stability of the community rated health insurance system and the safeguards provided to protect it, such as risk equalisation. This policy is designed with the express purpose of benefiting the insured population, particularly the elderly and the ill, who would otherwise be vulnerable to the effects of risk selection, and would find the cost of private health insurance unaffordable.
Risk equalisation seeks to remove an insurer's incentive to select preferred risks. It is clear from international health insurance markets that a system of risk equalisation and community rating is not incompatible with viable, ongoing competition. However, a market without the balancing measure of risk equalisation to address the effect of mandatory community rating exposes insurers with higher-risk members to spiralling claims and potential financial distress. Risk equalisation is not designed to over-compensate any insurance undertaking for the share of the total community of sick and elderly. It is about compensating for differential risk profiles rather than transferring profits. Its objective is to ensure that competition takes place on an equitable basis.
In December 2005, the Minister asked the Competition Authority and the Health Insurance Authority to examine the health insurance market and to bring forward recommendations on how greater competition might be encouraged. Their joint report is expected early in 2007. The Government is mindful of ensuring competition to allow consumers the choice to which they are entitled. It is the Government's view that the regulatory framework for private health insurance, including the provision for risk equalisation, is appropriate. This position has been endorsed by the High Court in a comprehensive judgment delivered last week. The written judgment is not yet available and will need to be carefully analysed by all concerned. While the Government accepts that the framework influences the market environment, it does so for a good reason, namely, the protection of the consumer and in the interests of the common good.
Hospital Services.
Following the publication several weeks ago of a Comhairle na nOspidéal report on neurosurgical services, it became clear there was to be the continuation of only two units in the country. Galway was not to have a unit. The report claimed the provision of a third unit would impinge on the viability of the other two. However, the report makes the best case possible in support of the provision of a unit in University College Hospital, Galway.
This time last year the Minister for Health and Children, Deputy Harney, visited University College Hospital, Galway. She indicated that neurosurgical services should be established in Galway as part of the Government's health strategy. She claimed such a service was required if there was to be regional autonomy. Certain accident cases requiring specialist neurosurgical treatment could not be transferred to Dublin for distance reasons. The case for the service in the west was made to her in an impressive presentation before Christmas last year. It is ironic that the position has changed.
Neurosurgeons at Beaumont Hospital have said that a State-run emergency air ambulance service would be preferable to establishing a neurosurgical unit on the western seaboard. They acknowledged there could be an argument for a unit for emergencies and spinal injuries.
Six reasons were given in the report why a neurosurgery unit should not be located in Galway. These are in fact the best reasons there should be. The Comhairle na nOspidéal report team comprised four medical people and two lay people. The report stated there was an "insufficient catchment population to maintain the skills of staff in a Galway unit". It stated 750,000 was the population figure needed for a viable unit. Despite this, the report's appendix B stated such a unit in Galway would cover the old western health board area of Galway, Roscommon and Mayo together with north-west Donegal, Leitrim, Sligo, Clare, parts of Limerick, north Tipperary, Offaly and Westmeath. This catchment area, as the appendix stated, comprises 1.025 million people.
The report's authors visited Australia, New Zealand, Scotland and England to examine units there. Many of the units they visited catered for populations of fewer than 1 million people. The report stated that no small units had been opened in these countries, yet on 15 June 2006, a unit was opened in Waikato in New Zealand with a population catchment of fewer than 800,000 people.
They visited Aberdeen in Scotland with a population catchment of 500,000, the nearest to Galway. The report stated:
Aberdeen Royal Infirmary is the largest hospital in the Grampian region. It has in excess of 1,000 beds and provides a complete range of medical and clinical specialties, with the exception of heart and liver transplantation. The neurosurgical unit, with a population catchment of 500,000, is staffed by 3 consultant neurosurgeons, 4 consultant neurologists, 1 full-time consultant neuroradiology, 1 consultant neuropathologist and 2 consultant neuroanaesthetists.
The report continued:
Management and consultant representatives in Aberdeen stated their belief that the neurosurgery unit in Aberdeen is viable and necessary, particularly to ensure rapid access to services. It was stated that there is a need to increase the consultant staffing to 4 consultant neurosurgeons.
The Fine Gael Party leader, Deputy Kenny, in the Dáil today highlighted the crisis in neurosurgery. No one in the west is asking that they receive a service at the expense of Dublin or Cork. No new appointment has been made in Beaumont Hospital. The technical equipment in the hospital is breaking down. Two eminent consultants, including Ciaran Bolger, have stated that people's lives are in danger. The first conclusion of the report is fallacious and those professionals who put their names to it should not be allowed to go unquestioned.
The second conclusion stated there was insufficient catchment population to maintain the skills of staff in two regional units. One consultant in Cork has stated if the catchment area in Cork were encroached upon by the provision of an additional unit in Galway, there would be problems for the Cork unit. Unashamedly, he was stating the preservation of his patch and the turf war between Dublin and Cork is more important than the health and safety of people in the west.
The report also concluded that the establishment of a third unit would be likely to inhibit the development of a tertiary neuroscience centre. The Minister for Health and Children would not have made the statement she did on her visit to Galway last Christmas if that was the case.
The most damning conclusion of all concerned the changing trends in demands for neurosurgical services. The report claimed that with new medicines and medical procedures, fewer people are in need of neurosurgical services. However, statistics show there has been a 3% increase per annum in the demand for such services. Will the Minister of State ask the Minister for Health and Children, Deputy Harney, once and for all to support this request as she did 12 months ago. This report is an opinion. It is not policy.
Nobody in Galway is trying to hinder the development of those services in Cork or Dublin. A neurosurgeon in the United States has made an offer, with no strings attached, and €1 million additional funding is available from the widow of a former professor, Pat Dwyer. The equivalent of €5 million is available, with no strings attached, to provide this service. Why is Galway the second tier of all the services in the west? I do not think the Minister for Health and Children would allow that label to be used in this instance.
Mr. Power
I thank Senator Ulick Burke for raising this issue this evening. I am replying on behalf of my colleague, the Minister for Health and Children, Deputy Harney.
I welcome this opportunity to inform the Seanad of the position with regard to the development of neurosurgical services. The Health Service Executive, HSE, recently published a review of neurosurgical services in Ireland which was prepared by the former Comhairle na nOspidéal. It focuses, in particular, on the provision of adequate capacity and consideration of equity of access to neurosurgical services.
Neurosurgery is provided at the national centre in Beaumont Hospital and in Cork University Hospital. In summary the report recommends that the future development of safe, high quality neurosurgical services in Ireland would be best served by a two-pronged approach involving increased capacity in Dublin and Cork, and improved access to neurosurgical units, including transport and telemedicine facilities for referring hospitals.
The report identifies a clear need for significant investment in neurosurgical services. It states that the development of services must be contingent on organisational reform. This includes the need to put in place clear clinical leadership to guarantee service quality; to ensure appropriate linkages between neurosurgical units and crucially to develop clinical pathways with referring hospitals which do not have on-site neurosurgical services.
The HSE is committed to progressing the recommendations of the report to ensure the development of neurosurgical services in Ireland is in line with international best practice. A national neurosciences needs assessment is under way. Neuroscience includes neurology, neurophysiology and neurosurgery. This assessment is guided by previous Comhairle reports on neurology and neurophysiology and the recent report on neurosurgery. It aims to identify the requirements for neuroscience services as a whole across the country.
I understand an interim progress report is due to be submitted to the National Hospitals Office shortly and the final report will be submitted in February next year. The HSE is pursuing the development of additional neurology services in Waterford, Limerick and Sligo. This will facilitate the management of patients who live outside Dublin who may need neurosurgical opinions or interventions.
The Government provided an additional €3 million in 2006 to develop neuroscience services and the recently published Estimates for the Health Service Executive provide a further €4 million to continue these developments into 2007.
Comhairle na nOspidéal considered the case for a neurosurgical unit in Galway at length. Representatives of the Western Neurosurgery Campaign met the Comhairle committee to put their case for neurosurgical services to be located in the west. Comhairle's conclusion was that a unit in Galway would not be viable. It also considered that the needs of the entire population would be ill-served by the division of neurosurgical expertise and resources between three neurosurgical units.
The reasons for this decision include insufficient catchment population in the west; changing trends in demand for neurosurgical services; international experience on the viability of small neurosurgical units; significant scope for improving services by increasing capacity in existing units as well as providing improved transport and telemedicine facilities. Comhairle's conclusion is that the needs of neurosurgical patients would be better served by increased capacity in the existing units and the development of systems that promote rapid assessment, diagnosis of injury and transfer, than by the development of a third unit.
The report acknowledges that this decision will be a disappointment to many who have campaigned for the establishment of a neurosurgical unit in the west. The HSE is convinced, however, that the implementation of the recommendations of the report represent the best way forward in building a high quality neurosurgical service that will meet the needs of the entire population.
With regard to transport, the helipad and telemedicine, it will take €11.5 million in capital costs to provide helicopter transport and €4.1 million running costs per annum, making a total of more than €15 million. That sum would resource a three consultant unit in Galway.
The HSE is part of a situation in which the west does not count. The composition of that committee was biased in the first instance and that is why the situation is as described in the report the Minister of State has cited on behalf of the HSE. I urge the Minister of State to bring this to the attention of the Minister for Health and Children, who visited the location and saw the need there.
Mr. Power
I mentioned in my response that several people would be disappointed with this decision and obviously the Senator is one of them. It is unfair to say the committee's report is biased. The committee was given a job to do and I have explained the reasons for its decision. I will do as the Senator suggests and report back to my colleague, the Minister for Health and Children, Deputy Harney.
The committee ignored the terms of reference it was given.
The Seanad adjourned at 9.50 p.m. until10.30 a.m. on Thursday, 30 November 2006.