Vol. 448 No. 2
6 Mr. E. Byrne asked the Minister for Health, in view of the recently published statistics on the numbers of patients awaiting heart by-pass surgery, if he will accede to the request by St. James' Hospital, Dublin 8, for departmental sanction to open an open heart surgery unit to cater for 250 procedures; and if he will make a statement on the matter. [1661/95]
(Limerick East): Open heart surgery operations for adults, including coronary artery by-pass grafts — CABGs — are currently performed for public patients at the National Cardiac Surgery Unit in the Mater Hospital, Dublin and at Cork Regional Hospital.
My Department undertook an assessment of the medium term requirements for additional cardiac surgery facilities in 1992-93. Submissions were received from the Mater and St. James's Hospitals. It was decided in 1993 that open heart surgery facilities should be expanded at the National Cardiac Surgery Unit, at the Mater Hospital.
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 through put of open heart surgery at the hospital from 750 to 1,000 — an increase of 33 per cent. In addition, in 1993 and 1994, capital funding of £2.8 million was provided to facilitate the doubling of cardiac surgery at Cork Regional 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 which were associated with this development, were completed in mid-1994, include additional cardiac maintenance beds, intensive care facilities and high dependency facilities which are 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.
The developments at the Mater Hospital, together with the developments for cardiac surgery at Cork Regional 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 am satisfied that when all these additional facilities are operating at full capacity they will have a positive impact on the waiting list. 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 congratulate the Minister on his appointment as Minister for Health and I hope we will have a good working relationship. Unfortunately, he has not gone into any great detail to support the case I made for the development of the service in St. James's Hospital. Will the Minister not agree that in this day and age it is ridiculous that patients should be processed through a modern hospital with a large capacity like St. James's Hospital and transferred in huge numbers by ambulance to the Mater Hospital? Will he agree also that with 1,657 people waiting for cardiac surgery, it is now time to bring on stream other hospitals particularly St. James's Hospital to perform that surgery? Does it not disturb the Minister that the two private hospitals which do this procedure do 700 procedures per annuam and that it is sad that the two public hospitals in Cork and Dublin are only carrying out approximately the same number? Will he give the House a guarantee that he will reverse this incredibly serious imbalance in the service?
(Limerick East): Cardiac surgery is an area of increasing concern and it has received a certain amount of publicity during the past 12 months or so. In 1992-93 the Department undertook an assessment of the medium term requirement for additional cardiac surgery facilities and an option appraisal was carried out by the Department on proposals submitted by the Mater Hospital and St. James's Hospital. Those two hospitals were the only contenders as they were the only hospitals in Dublin with cardiac surgeons. The St. James's Hospital proposal was for a start-up facility of 250 cases. At present the cardiac surgeons in St. James's Hospital carry out their operations in the Mater Hospital. Without going into too many statistics, it was seen, on the assessment that there would be a better throughput of cases by expanding facilities at the Mater Hospital rather than setting up new facilities at St. James's Hospital. That was the basis for that decision.
As the Deputy said, there is a waiting list of 1,700 adults. When services are fully in place in 1995, the open heart surgery capacity of the public hospitals will be 1,000 in the Mater Hospital and 400 in Cork Regional, an increase of 450 on what was available before the assessment was carried out. I am aware that St. James's Hospital is continuing to press its case and wishes to become a second centre for cardiac surgery in Dublin. Its case will have to be taken into account in any further expansion of the service. It is also worth pointing out that the Western Health Board is seeking cardiac surgery facilities which will be headed by two cardiac surgeons in Galway and the Mid-Western Health Board has also plans in this area. So there are a number of competing demands for resources now, but the priority is to continue the throughput of cardiac operations in the public hospitals and to continue what is happening in the private hospitals where approximately 700 operations are performed per annum at the Blackrock Clinic and the Mater Private Hospital. If, as the Deputy suggests, there is a discrepancy in the throughput between the public and private hospitals, I will have it examined, but I have no information on file to suggest that is the case.
As a Government backbencher I do not wish to add to the Minister's headaches, but I am sure he and his officials understand the horrendous difficulties he would face if, having put all one's eggs in one basket in terms of providing cardiac surgery in the Mater Hospital in Dublin, a doomsday scenario arose which resulted in that hospital having to close its wards as a result of an infection. There is no alternative public hospital in the Dublin area equipped to carry out that surgery. Will the Minister seriously investigate the strong case that Dublin needs a second cardiac surgery facility in addition to that provided in the Mater on the grounds that if the Mater had to close there would be mayhem in this life and death area?
(Limerick East): I understand what the Deputy is saying and the case being made by specific people in St. James's Hospital is known by the Department. It will be considered again in any future expansion of cardiac surgery facilities. The priority should be to carry out more operations satisfactorily instead of fewer in two strategic locations rather than one.
Given the waiting lists mentioned, is it not an uncomfortable fact that access to this life saving operation is determined by whether one can pay for it? Is this not something that in all equity the Government should consider?
(Limerick East): No, I do not accept that. In 1995, approximately 1,400 operations will be carried out on public patients in the Mater and in Cork Regional Hospitals and 700 in the Mater Private and the Blackrock Clinic. I do not accept the Deputy's suggestion although I agree the waiting lists are long. However, there is no waiting list in respect of children.
Has the applications from St. James's Hospital been costed by his Department or by the hospital? Has the hospital indicated it might be able to meet the resources required for this facility from within its existing budget, that the appropriate staff would be available from within the hospital or that facilities, including space for the unit, would be available?
(Limerick East): I am prepared to consider any proposition made to me by a reputable group. St. James's Hospital is one of the leading hospitals here and has some of the finest medical practitioners.
The Minister indicated that proposals were made by other health boards regions, including Galway and the mid west. The waiting list for this operation is not peculiar to Dublin patients. People throughout the country are awaiting the operation and the closer the location of the hospital in which the operation is carried out professionally and expertly, the more life saving it would be.
(Limerick East): This is a countrywide issue, but cardiac surgery cannot be carried out in hospitals in every county or health board area. We are trying to maximise throughput by concentrating on the most effective number of centres and proximity to the hospital where surgery is carried out is not a primary issue.
Has the Minister considered the proposal from St. James's Hospital to use an American system Psicor, who made an offer to establish a base in St. James's Hospital where they could deal with 250 patients per annum. The throughput cost per patient would average £1,300 in contrast to the average cost today of £8,500. Will the Minister consider that proposition and let the House know at a later date his opinion on its feasibility?
(Limerick East): I have not evaluated that proposition, but if the Deputy puts down a separate question on the matter I will provide him with the information at a later date.
