Dinny McGinley
Ceist:18 Mr. McGinley asked the Minister for Health the number of patients currently awaiting heart surgery; and the steps, if any, he proposes to take to alleviate this problem.
Ceisteanna — Questions. Oral Answers. - Cardiac Surgery Patients.
There are 1,335 patients awaiting cardiac surgery as at 30 April 1993. Heart surgery for public patients is performed in three locations; the National Cardiac Centre, Mater Misericordiae Hospital, Dublin, Cork Regional Hospital and Our Lady's Hospital for Sick Children, Dublin.
The cardiac surgery waiting list which includes patients from all health board areas is reviewed by the cardiac consultants on a regular basis to assess each patient and to determine the priority attached to each case. The admission of a patient to hospital is a clinical decision taken by the consultant concerned and is based solely on the patient's condition. Twenty million pounds will be provided in 1993 for a major action programme to reduce hospital in-patient waiting lists. Cardiac surgery will be a priority in the allocation of funds for this major action programme and I will be announcing my decision in this matter in coming weeks.
Having regard to the fact that the Minister said he is going to put in place a plan of action with specific reference to heart surgery, does he agree with the comments of his predecessor that heart by-pass surgery is a fashionable exercise and not one that requires urgent medical attention?
That is not a view I share.
On the question of reducing the waiting list of 1,335 patients, how many operations is it intended will be carried out in the Mater Hospital in 1993? Will the Minister refer specifically to the extra unit at St. James's Hospital and say whether he is in favour of work proceeding on that unit in 1993?
Submissions from both Cork and the two Dublin units, the Mater Hospital and St. James' Hospital, have been made to me. To give Deputies opposite a view of my intentions in this regard, approximately 1,000 cardiac operations were performed last year. With the resources available to me I can make significant improvements in those numbers. The total in Dublin last year was of the order of 750 and I hope to raise that figure to 1,000. The total in Cork was of the order of 200 and I hope to raise that to 400 which, annualised, would be the extent of the total waiting list.
Is it not the situation that a two-tier health service exists and that if any one of those 1,335 patients can beg, borrow or steal £10,000 he or she can have a heart by-pass operation tomorrow in the Blackrock Clinic or the Mater Private Hospital? Is the Minister aware that the terminology of his reply to Deputies in relation to urgent representations being made to him regarding patients in our constituencies is exactly the same as that given by his predecessors, Drs. O'Hanlon and O'Connell? In other words, if the patient's condition gives rise to complaint he or she should consult their GP. That is making a fool of very sick people. The Minister should at least show some creativity and change the terminology of his replies. Will the Minister treat this as a priority because in most cases it is a matter of life and death?
The Deputy prepared his supplementary question before listening to my reply. I said I intend increasing the number of heart operations in Dublin from 750 to 1,000 and in Cork from 200 to 400. This will represent the most significant increase ever. That is a measure of the priority that I attach to these matters. I am not happy with the present position and am determined to address it. That is why I have fought hard to obtain resources from Cabinet to carry out an initiative on waiting lists.
In relation to the terminology of my replies, obviously a patient's need for treatment is a clinical decision. No one in urgent need of a heart operation should be deprived of that if the clinical decision is that it is urgent. There will never be a time when we will have no one on waiting lists. That is not possible regardless of what resources we provide because there are always new patients arriving to be treated. I intend to maximise the provision of heart surgery and a number of other specialist surgical procedures and I will make a significant impact on these procedures in the next 12 months.
While I welcome the Minister's efforts to redress the balance he has given in his reply the misleading impression that obtaining heart surgery is need-based when we are all aware it is money-based. If one can afford to pay for treatment privately the chances of getting an operation are hugely increased. Would the Minister agree that there is a double disadvantage for public patients because the poor socio-economic factors related to cardiac conditions are such that if one is poor one is more likely to suffer from a serious cardiac condition? That is a hidden disadvantage for the people on waiting lists for major surgery to relieve their condition. I appreciate the Minister is dealing with the problem of waiting lists and is trying to provide additional resources. However, if he does not address the inherent contradiction within the health service in relation to this type of treatment, inevitably, those people who most need treatment are those who will be unable to avail of it because of the present two tier system. Simply shoring up an existing system, which is based on inequality, will not address the problem because next year the Minister may find that another sector within the health service is requesting emergency funding and he will be unable to deal with the problem.
I am responsible for the public health service and that is what I have been examining. In relation to specific perceived needs, one of which is heart surgery, I am determined to make significant improvements. I have outlined to the House significant targeted improvements that I intend to achieve. It is true that we have private medicine here also. The only way to achieve what the Deputy has suggested is to outlaw private medicine.
Stop subsidising it.
If private medicine exists people are entitled to avail of it and will do so. I have no intention of outlawing it. It is a service provided for people. It is my responsibility to optimise the public health service. My colleagues in Government agree that resources should be allocated to make the necessary changes in relation to this matter. The Deputy who shouted we should stop subsidising it will find inherent in the charges, and the increasing charges this year, that the largest amount of money was allocated to secure a better return from private patients in public hospitals for the faciities available to them. That measure will be resisted in some quarters.
(Carlow-Kilkenny): Would the Minister accept that many of the operations are emergencies and people are not being taken off the waiting list? We are all pleased that surgeons carry out emergency operations but people who are on the waiting lists do not move up the list unless they have a heart attack or others on the list die. I accept the Minister's bona fide plan to improve the system, but will it cater for people on the waiting list? Surgeons are run off their feet and I express my gratitude to them. I see them as the present day Florence Nightingales of the medical service. People only realise the work surgeons do when those close to them undergo operations. I appeal to the Minister to implement some measures that will relieve their workload and enable them to carry out their good work.
I agree with the Deputy that we are very fortunate to have such gifted people at every level in our health service, particularly in the area now under discussion. We have very talented, competent world-renowed people and first class facilities that attract attention worldwide. I am determined to improve those facilities and ensure that sufficient resources are available to make the improvements I outlined.
I asked the former Minister if he would review the waiting list in view of its age. Some of my constituents have been on the waiting list two years. Will the Minister ensure that those who have been two or more years on the waiting list are treated as priority? Perhaps the basis for treatment could be the date of diagnosis.
I understand Deputy Carey's anxiety in regard to people who have been a long time on the waiting list. However, the decision in regard to dealing with the waiting list is a clinical one made by a doctor on the basis of need. I discussed this with specialists. Some patients may be diagnosed as in need of by-pass surgery but not immediately. Sometimes it is suggested it would not be in their interest to have such surgery in the immediate term. That may sound fanciful but that is the case in some instances. The length of time is not always the determining factor. If 1,400 or more procedures were carried out annually and there is an annualised waiting list of about 1,300, we should have a full patient turnover annually. Obviously, emergency cases and those in clinical need will be given priority but there should not be long waiting lists.
Would the Minister, who said he is responsible for public health services here, agree that he should take care not to upset the fine balance between the private and public sectors in relation to health services? That responsibility lies with the Minister. If the Minister puts a lot of pressure on private medical care by pricing it out of the market, that will impinge on the public health care system. The Minister must balance the needs of the two sectors.
It will be difficult for me to frame a response that will please both Opposition spokespersons.
Do not try.
My role is to be primarily responsible for the public health service but I am mindful of the fact that most people who avail of private medicine are contributors to the public health services, because they pay PRSI contributions, and are entitled to avail of a public hospital. My only function in terms of distinguishing between the two is to have a clear view of those who opt for private and those who opt for public care. People who opt for private care should be charged something approximate to the real cost of providing it. I have moved towards that and I will continue in that direction in a way that allows the balance to which the Deputy referred to be maintained. I do not intend to abolish private medicine.
I am delighted to hear an espousal of social policies from the Minister with regard to private medical care. The Minister referred to specific targets with regard to clearing the list this year. I put it to the Minister that a figure of fewer than 1,000 operations in the Dublin area, means in effect that the proposed unit at St. James's Hospital will not be proceeded with having regard to departmental targets and that the unit in the Mater Hospital could cater for 1,000 operations in a year. What is the position regarding the proposed unit at St. James's Hospital?
I have already answered this question. I have two proposals, one for the Mater and one for St. James's in relation to increasing the number of Dublin operations to 1,000 at which I will look carefully. It may be possible to exceed that target, which will please me greatly.
The Minister mentioned that people eligible for public care opt for private care. Is that not an indictment of the difficulty in getting public care? Many people cannot afford to make that choice. I do not have a problem with private medicine as long as people pay the price. Will the Minister agree that it is immoral to allow the very rich to be subvented by the taxpayer, through their VHI premiums, in the Blackrock Clinic, when resources are so scarce that we should concentrate on those in need, still awaiting the treatment they deserve?
I expressed my view on private and public medicine. My primary responsibility is to maintain and develop the public health service to the best of my ability. An analogy that one could use is that if one is flying to America one can travel tourist or premier class——
Not at the taxpayers' expense.
——on Aer Lingus. I am anxious that private medicine is available but that it would not ultimately determine the quality of medical care. I accept what the Deputy said about moving towards a situation where people who opt for private care pay something approximate to the cost of the provision of that service. It is not acceptable that a significant cross-subsidy should exist between the public and the private health service. I have already had discussions with various organisations and hospitals about that.