With the agreement of the House, I propose to share time with Deputy Enright.
Adjournment Debate. - Cardiac Services.
Is that agreed? Agreed.
I raise this matter because it highlights the huge difficulties caused to families by the unacceptable waiting time for children to have essential cardiac surgery.
Last night's Evening Herald highlighted the story of baby Craig Gibbons and his mother and father. Baby Craig is 15 months old. He is one of 96 children awaiting heart surgery in Our Lady's Hospital in Crumlin. The main artery in his heart has a blockage and is closing slowly. While Craig waits for essential cardiac surgery, he is dependent on antibiotics to keep him alive and well, and on regular attendance by his local general practitioner.
The Gibbons family are fortunate in that the father works, and works extremely hard, and as a consequence they do not qualify for a medical card on financial eligibility grounds. No child should have to wait 15 months for such surgery. It is a scandal. It highlights the gross failure of this Government to ensure that children get the essential medical care to which they are entitled.
Craig's parents are rightly concerned, and they want the surgery carried out as soon as possible. Their worries are exacerbated by the fact that the delay in the surgery is putting huge emotional and financial pressure on the family. The cost of medicines and GP attendance is such that the burden has become unacceptable. The Evening Herald reported last night – and it has been confirmed by my colleague, Deputy Tom Enright, who knows the family – that this family sought to have a medical card made available to it by the Midland Health Board and were refused. The health board has said that as the family does not fall within the financial eligibility, the child cannot have a medical card.
It has been suggested to the father – and this is outrageous – that he should render himself unemployed and the health board would then make a medical card available to him. An official of the health board said that there is no provision under the medical card scheme to grant a medical card generally on the basis of disability or illness except where specifically directed by the Minister for Health and Children. That is incorrect because, in such circumstances, a health board has discretion to issue a medical card.
I call on the Minister, first, to ensure that this child rapidly has the surgery to which he is entitled and, second, to make contact with the health board to query why it does not understand the workings of the medical card regulations and legislation. He should find out why it is not exercising the discretion that must be exercised in this case, which is to make available a medical card to this family for the benefit of this baby, in order that the father can stay in employment and the family can cease to be under the degree of financial pressure they currently face as a consequence of the inability of the health service to provide essential cardiac surgery within a reasonable time when it is required.
I make a special appeal to the Minister for Health and Children to grant a personal medical card to Craig Gibbons, who is aged 15 months. Craig is on a waiting list at Our Lady's Hospital, Crumlin for an operation for a hole in his heart. His life is in danger as the hole in question is a medium to large one. He was diagnosed with this ailment on the day of his birth. The main artery to his heart is closing, resulting in the blockage cutting off the supply of oxygen to his body. His health is such that he turns blue on occasions and is unable to breathe. This is alarming for the boy and for his parents. He is on constant medication and has to travel from his home in Crettyard in Laois to Crumlin hospital, where he is very well looked after when he attends on a regular basis. His immune system is weak and he constantly catches colds. His health situation is so serious that if he does not have the operation by June, he will have to go to the Great Ormond Street Hospital in London for it, at additional cost.
His mother, Anita, had to give up work to care for him. When the family applied to the Midland Health Board they were refused a medical card. I contacted the health board and was told he was refused on financial and medical grounds, which I find hard to believe, because full medical evidence was submitted, along with the application form. The facts I have stated here are exactly as outlined in the medical report which was sent to the health board. The child is not covered by the VHI and his father has to pay all the additional doctors', surgeons' and chemists' bills. I am amazed and disappointed that the Midland Health Board has refused a medical card in this instance.
Let it be clearly understood that Mr. Gibbons and his wife want a medical card for their son only. They do not want it for anybody else in the family. I make two appeals to the Minister, first, to do everything in his power to expedite the operation for Craig and, second, to direct the health board to immediately grant a medical card to Craig Gibbons. Guidelines are only guidelines. In a very sensitive case of this nature where a boy's life is at risk, common sense, discretion and humanity must play their part in arriving at decisions. Such hard-line decisions as evidenced here must stop. The Minister should talk to the health boards to ensure that such a situation never arises again.
In this instance a medical card must and should be granted to Craig. There are at present 96 children who have been waiting for up to two years for vital cardiac operations in Our Lady's Hospital, Crumlin. At a time when we are experi encing an economic boom, this is not acceptable. I ask the Minister to provide additional nurses and a consultant paediatric cardiac surgeon, and to complete work on the two operating theatres at Our Lady's Hospital Sick Children, Crumlin. I believe the Minister will make sure a medical card will be granted in this case, and I thank him in anticipation of it. I also thank the local general practitioner, Dr. Jonathan Jacob, and the surgeons, nurses and other staff at Our Lady's Hospital for Sick Children in Crumlin who have been so kind to Craig. However, it is an outrage that this sort of situation should arise in this day and age.
I thank both Deputies for raising this issue. The reduction of waiting times for children requiring cardiac surgery at 0ur Lady's Hospital for Sick Children, Crumlin, which is the national paediatric cardiac centre, is a priority of mine and of my Department. In 1997, during discussions with the authorities of Our Lady's Hospital for Sick Children and officials from my Department, we were informed that the reasons for the increased pressure on the hospital's cardiac services were due in the main to the lack of theatre space and ICU beds, a shortage of trained ICU nurses and advances in the surgical and intervention techniques available.
In December 1997 the hospital was allocated a sum of £500,000 from the cardiac waiting list initiative to implement measures aimed at reducing pressures in this area in the most effective and appropriate manner. The hospital used this funding to provide additional ICU beds, to implement a training programme for ICU nurses and to purchase a number of cardiac procedures from appropriate UK paediatric hospitals.
In 1998 and 1999, under the same initiative, the hospital received further funding of £878,550 and £340,000 respectively, which enabled the hospital to maintain its training programme and to continue to purchase cardiac procedures from the United Kingdom. As of 31 December 1999, 135 children had cardiac surgery funded by this initiative. My Department has already allocated £700,000 to allow the hospital to continue with this initiative in 2000.
However, it is both my Department's and the hospital's position that the purchase of cardiac procedures from the UK is an interim measure, and that the best way to significantly enhance paediatric cardiac surgery is to increase Our Lady's Hospital's surgical capacity. In this regard officials in my Department are working in conjunction with the authorities on a major theatre development for Our Lady's Hospital. It is envisaged that when completed, the new theatre development will provide five new operating theatres, complete with ancillary accommodation, a day surgery area and a central sterile supplies department.
The existing theatre facilities will also be upgraded to provide a further two theatre suites. When these theatres are fully commissioned it is expected that Our Lady's Hospital for Sick Children will be able to perform an additional 100 paediatric cardiac procedures a year, which is a 40% increase on its existing capacity. It is expected that this development will be completed in 2002.
Under the Health Act, 1970, determination of eligibility for medical cards is the responsibility of the chief executive officer of the appropriate health board. That is a statutory obligation and responsibility. Medical cards are issued to persons who, in the opinion of the chief executive officer, are unable to provide general practitioner, medical and surgical services for themselves and their dependants without undue hardship. The determination of eligibility rests with the chief executive officer of the appropriate health board and I understand the board has carefully considered this request.
The Minister of the day does not have a function in issuing medical cards to individuals. I have made inquiries with the health board concerned and I can confirm what Deputy Enright has said – that they are identifying the financial issues, as a factor in not issuing a medical card.
Income guidelines have been drawn up by the chief executive officers to assist in the determination of a person's eligibility and these guidelines are revised annually in line with the consumer price index. However, the guidelines are not statutorily binding and even though a person's income exceeds the guidelines, a medical card may still be awarded if the chief executive officer considers that a person's medical needs would justify this. Medical cards may also be awarded to individual family members on this basis. So, the wherewithal exists for a health board to grant a medical card in these circumstances.
The health board's behaviour is outrageous.
I understand the child in question was placed on the waiting list for cardiac surgery in Our Lady's Hospital on 11 October 1999 – that is the date that I have been advised of – and was reviewed again on 7 January 2000. While the hospital is unable at this point to give a definite date for surgery, it expects that it will be carried out within the foreseeable future. However, it is important to note that the possession of a medical card would not affect the child's position on the waiting list, which is decided on grounds of clinical urgency. It is something which the clinicians decide.
People who do not hold a medical card are entitled to a broad range of health services including an entitlement to public hospital and public consultant treatment, subject only to modest statutory charges, and out-patient services free of charge. There are also a number of schemes which provide assistance towards the cost of medication. Under the drug payment scheme, a person and his or her dependants will not have to pay more than £42 in any calendar month for approved prescribed drugs, medicines and appliances.
As regards the general issue of cardiac waiting lists for children I am confident that as we have approved additional human resources – which will be in place by July 2002 – and when we have increased the surgical capacity, under the general medical scheme we will be able it improve waiting time significantly, as I have outlined. I intend to make further inquiries of the health board concerned in relation to the issues the Deputies have legitimately raised.
I will be getting back to the Minister about this on Tuesday. It is a very serious matter of the utmost concern.
Please, Deputy Enright, both Deputy Shatter and yourself have done very well. We have spent 13 minutes on that issue. It is Deputy Farrelly's turn now.
As a medical practitioner yourself, a Leas-Cheann Comhairle, you will realise it is an important matter of the utmost concern.
I appreciate that.