Dr. Liam Plant:

Senator Crown asked about staffing levels. I can provide him with the exact staffing level for nephrologists, which will likely reflect on the other specialties in question. The mean number of consultant whole-time equivalents per million of the population in the United Kingdom is 7.4. In the Republic of Ireland, it is 4.6. There is also a regional disparity, with about 6.3 per million in the HSE Dublin north east region but 5 in the HSE south region, 3.8 in the HSE west region and 3.6 in the HSE Dublin mid-Leinster region. The second metric, which is similar, is the mean number of consultant whole-time equivalents available per 100 end-stage kidney disease patients. In the UK it is 1.1, while in the Republic of Ireland it is 0.6. Again, there is regional variation. These data are accessible on our website at hse.ie/nro.

I profoundly agree with Deputy Catherine Byrne on the fact that there is no pot of gold at the end of the rainbow. However, we have revenue locked within the programme for treatment of end-stage kidney disease. There is €100 million for costs attributable to dialysis. If a proportion of those patients received a transplant, that revenue would no longer be required. With respect to Senator Crown, I do not believe we will have a situation in which we will not dialyse people. I cannot envisage that happening. However, if we do not increase access to transplantation, the numbers on dialysis will continue to increase.

We have reduced costs dramatically in the past three years, but no matter how cheap one makes it, a patient has to have this treatment 156 times a year. Senator Crown used the word “malfunded”. The taxpayer, through the HSE, is funding end-stage kidney disease treatment. It is a question of which way we want to do this. Unusually for a health care issue, in this case the treatment that is the highest quality and has the best outcome is the cheapest.