Mr. Mark Regan:

As the only Irish hospital group with hospitals on both sides of the Border, one in Sligo and one in Belfast, Kingsbridge Healthcare Group was uniquely positioned to facilitate the flow of patients in both directions when the cross-border directive was operating up to December last year. The volume of patients travelling from the South to the North dwarfed the volume travelling in the reverse direction. There was a host of reasons for that, including, but not limited to, the exchange rates and the lower cost of private surgery in Northern Ireland than in the Republic of Ireland, which ultimately resulted in lower financial shortfalls for patients. That is an important point I will return to momentarily.

Typically, we find that clinical outcomes are directly proportional to any delay between the date of a referral through to the date of treatment, if it is in any way protracted.

While the Irish State does not have the capacity to treat every patient on a waiting list, obviously, the continuance of this scheme beyond December 2021 would allow for many more patients to access treatment in a timely fashion.

It is of note that the cost to the public purse of patients accessing the scheme is similar to that if they had accessed it within the HSE. Any gap or shortfall, while minimal, is picked up by the patient and not the State. The shortfall relates to the procedure only and not travel, which is excluded from the scheme. On that basis, accessing the scheme through Belfast means they are availing of a lower-cost surgery and thus a lower shortfall, as well as minimising the cost of any additional travel by staying on the island of Ireland. While patients can use the scheme for any consultation, scan or surgery that they can get within the HSE system, the majority of patients by volume present to be assessed for ophthalmology, orthopaedics, gynaecology, urology, neurospinal and ear, nose and throat, ENT, services.

While Kingsbridge offers support and education schemes through a one-to-one service in its Belfast hospital, it is not always possible to know which patients are using the scheme and others who simply may be medical tourists outside this scheme completely and attending from just over the Border to come to Belfast for timely treatment through private treatment. Since the autumn of 2017, we estimate that of the total episodes of care, approximately 28,000 have come from the Republic of Ireland to Kingsbridge Belfast. The Border counties, that is, Leitrim, Donegal, Cavan, Monaghan, Louth and Meath, typically account for approximately 6,500 patient episodes. Total surgeries come to approximately 8,000 and there were approximately 10,000 first consultations. It is also notable that approximately 1,300 patients have travelled from counties Cork and Kerry, showing that distance travelled on the island is not an issue or a barrier for them.

It is crucial to note that the scheme is used predominately by those with little or no disposable incomes and by those who cannot afford private healthcare in any fashion. The majority of the patients will use bank or credit union loans to cover the cost of surgery while they await that refund from the State. The average age is between 50 and 75 years, and many of them will rely upon relatives to support them in the journey to Belfast. This last point is of particular note when one considers that if the scheme is not passed into Irish law before December this year, they will be forced to travel to mainland Europe if they wish to avail of this type of scheme. This has implications for increased cost, which is not refunded, and would be an additional burden to the family to support the patient travelling through an airport system.

It is also of note that numerous medical colleges advise against flying in the days and weeks post surgery, unless accompanied by a medical team. The other option is to wait on the public system in Ireland but the table I have provided to members today will give some examples of why this becomes a problem. I will not got through these as it is available to the committee online. In essence, however, I have given figures around muscle decay becoming fatty infiltration while the patient waits. This is never recovered post-surgery with a host of problems. In hip replacements, patients can become addicted to pain relief. Even after the surgery they find it difficult to wean themselves off that. The actual surgery itself is technically more difficult whenever a patient has been waiting for three, four or five years and is down to bone on bone before he or she can have the surgery, and therefore the complications rate is also significantly increased. I have also submitted a list on cataracts to members that will raise similar points on the complexity and importance of getting early intervention within a year or so, and not three, four or five years, as we see with many of the patients who come to Belfast.