Dáil Éireann díospóireacht -
Thursday, 24 Feb 1994

Vol. 439 No. 4

Ceisteanna—Questions. Oral Answers. - MRI Scan Appointments.

Ned O'Keeffe

Ceist:

11 Mr. E. O'Keeffe asked the Minister for Health if he will have arrangements made to investigate the appointment system for people in need of an MRI scan at Beaumont Hospital, Dublin 9, in view of the fact that private patients are receiving early appointments while public patients have to wait many weeks; if his attention has been drawn to the fact that this MRI scanning machine was purchased by the State solely for use by public patients and that it is one of only four such machines in the country, three of which are located at private hospitals and therefore used solely by private patients and that the hospitals referring patients for a scan at Beaumont are being charged for the scan; and if his attention has been further drawn to the fact that there is a young public patient in the Cork area who has been hospitalised for several weeks and had been informed that he would have to wait until late January 1994, for a scan despite being an emergency case.

Mr. Howlin

The MRI facility at Beaumont Hospital was provided on the basis that it would serve both public and private patients, with private patients paying a charge for the facility. The funding arrangements for this facility, both capital and revenue, were based on the income that would be generated from both public and private sources. The arrangements in relation to the charges were communicated to all health boards and voluntary hospitals by my Department in July 1993. Where health boards or other public hospitals refer public patients to Beaumont Hospital for this service, the charge is made on the agency making the referral not on the individual public patient.

As an MRI facility is a very expensive state-of-the-art service, referral Protocols for the use of this service have been circulated to all health boards and voluntary hospitals. These Protocols are essential to maximise the clinical efficacy of the facilities and to ensure that all suitable patients obtain access to the service. I understand that the referral Protocols are working well in practice, and that any queries which have arisen have been satisfactorily resolved.

While the clinical indications for emergency MRI examinations are relatively few, the appointment system for MRI scans at Beaumont Hospital provides that emergency cases are given priority where necessary.

In relation to the particular case referred to by the Deputy, it has not been possible to identify the patient, based on the information supplied. In order to investigate the matter further details would be required as to the name and address of the patient, the nature of the emergency and whether the case was discussed with a consultant radiologist at Beaumont Hospital. If the Deputy wishes to communicate these details to me, I would be happy to look into the circumstances of this case.

Mr. Allen

Will the Minister agree that the position as set out in the question is an example of the haphazard approach to the delivery of hospital services? There are now four magnetic resonance images scanners in the Dublin area at a cost of approximately £2 million per machine while there is no such facility in the rest of the country. Every year at least 100 people from the Cork-Kerry region have to travel to Dublin at a cost of £400 per scan, plus travelling expenses and inconvenience. Will the Minister agree it is time the voluntary, public and private hospitals came together with a view to setting up an integrated and organised approach to the delivery of high-tech medicine? This is a symptom of the fragmented way in which everybody is doing their own thing.

An Ceann Comhairle

The Deputy has made his point.

Mr. Howlin

I do not accept that the delivery of the public health service, for which I have responsibility, is haphazard. Unfortunately, I have no control over the purchasing policies of the private hospitals. If a number of private hospitals want to compete with each other and decide to buy an expensive item of equipment I have no control over that. We can sustain one machine in the public sector which is in Beaumont Hospital. That machine was acquired at a good price in co-operation with Northern Ireland—the only one in Northern Ireland—was bought at the time we bought the machine for Beaumont, thus reducing the cost significantly to the Exchequer. I want to have supported the practice of private medicine in the public hospital sector, first, to ensure that private patient moneys is available in public hospitals and, second, to ensure that the best consultants remain in the public campus and do not go to private practice. The Protocols agreed for the MRI scanner at Beaumont Hospital are in the public interest. Unfortunately, I have not control over the purchasing practices of private hospitals.

Mr. Allen

Surely the Minister has control over the purchasing practices of voluntary hospitals as they are funded directly by his Department?

An Ceann Comhairle

I would prefer if questions referred to Beaumont Hospital.

Mr. Allen

That is fair enough, a Cheann Comhairle, but it is part of the overall policy.

An Ceann Comhairle

The question deals primarily with Beaumont Hospital.

Mr. Allen

On what basis was the decision made to locate an MRI scanner, admittedly at a knockdown price of £1.8 million, at Beaumont Hospital when similar scanners were located in three other Dublin hospitals? There is no scanner of that type in any other part of the country. Was it based on a decision to centralise everything in Dublin?

An Ceann Comhairle

This is a rather specific question.

Mr. Howlin

The national neurological centre is in Beaumont. It was clear that the national neurological centre, which deals with patients with head injuries from all over the country, should have this facility.

Mr. Allen

Will the Minister concede to the urgent need for a scanner to be located outside the Dublin area? Will he concede to the request from the Southern Health Board to have such a scanner located in the Cork Regional Hospital and will he indicate when he will give the go ahead for such a scanner?

Mr. Howlin

The Deputy has been successful already in getting a consultant for Cork. He should be content with one outing in the day. I have requests for very expensive high-tech machinery from every region. I am satisfied that the current level of facility for MRI scans is sufficient. In determining the expenditure of scarce resources I must be sure when spending £2 million on an item of equipment there is an absolute and compelling reason for it. If we had six such scanners they would be an additional diagnostic tool but I have to be convinced that new equipment significantly adds years to life or life to years before I approve it.

Mr. Cullen

Will the Minister agree it is not so much the location of this sophisticated equipment that is important but rather the waiting list for access to them? People outside Dublin are frustrated in trying to gain access to this equipment. What will the Minister do to ensure that public patients can have access to this equipment as quickly as possible because the perception is that it is for private patients only?

Mr. Howlin

That perception is completely wrong. It is almost exclusively for public patients with some facility for private patients.

Mr. Cullen

That is not the perception.

Mr. Howlin

That is not the case and I would not like the Deputy to mislead anybody in that regard. The facility in Beaumont is primarily for public patients. Only three complaints have been received about access from clinicians since the machine was installed, all of which, on consultation with the radiologist concerned, have been satisfactorily resolved. An evaluation of the use of the machine has been carried out by a clinician from the Royal College of Physicians in Ireland. The final draft report of the evaluation, which has been received in my Department, concluded that the MRI is providing an effective and efficient service.

Mr. Allen

Would the Minister accept that it is utterly unsatisfactory to have four machines worth £2 million each located within a ten mile radius of Dublin while the rest of the country does not have any such facility and people have to travel all over the country at considerable expense and suffering to avail of the service? Could we have some organisation in the allocation of resources to the health services?

Mr. Howlin

The Deputy is being deliberately unfair. I understand the Deputy's regional focus but I have a national responsibility. I do not come from Dublin nor do I represent a Dublin constituency but I do not expect everything to be located in Wexford. One third of the population is based in Dublin and there is one MRI scanner available in the public health services. It is the only one over which I have control and it is logical to put the one machine in the centre of the largest population and more importantly to put it in the national neurological centre.

Mr. Allen

Does the Minister fund some of the other hospitals?

Mr. Howlin

I do not fund any of the private hospitals and I do not have any responsibility for the private hospitals.

We have one MRI scanner in the public health system and if private institutions in Dublin, Cork, Galway, Limerick or Wexford or anywhere else choose to provide equipment privately, I have no control over that.

Mr. Allen

The Minister has, of course, through the VHI.