Professor David Keegan:

This is one area that does concern us, because we do not have full visibility of the patients that are being referred directly out of the State to avail of the cross-border directive. They are coming from all parts of the country. Prior to the EVSAs, we had made an assumption that the travel of patients from the NERIECS region, that we talk about today, was very low, but it comes from one of my colleagues, Seán Paul Teeling, who engaged with the voice of the customer - with the referrers - we came to realise that large numbers of patients, up to 20 a week from one optometric practice are being referred to Belfast for surgery. This presents a problem for us in that we cannot fully demand a model based on how much capacity we actually need. We are basing it on our current wait list and demographic growth, but we may need to bring more capacity in as we get a better idea of what the full demand is. We have engaged with the optometrists and GPs in the region through this process. There has been really broad engagement and agreement that this is the right thing to do. In fairness to the referrers acting on the patients' best interests, they feel they cannot switch that system off until this is fully up and running.

We are excited to be getting our new theatres so we can demonstrate that tripling of the capacity for cataract surgeries through the Mater so they will not need to do it. However, I do need to point out that there is often a misconception that treatment abroad in Belfast involves patients going to an NHS unit to be treated up there, as they are going to a private facility in Belfast. We actually have the bizarre situation whereby, in another role, I do surgeries in the Mater Private Hospital and I am asked to operate on patients from the NHS service in Belfast who come south to Dublin for their surgeries.

There is an odd situation on the island whereby patients in the Republic are going to Belfast for surgery and patients from Belfast are coming to Dublin for surgery. Through NERIECS, we are hoping to provide enough capacity through this model to address demand in the region. The modelling in the slide I showed, carried out by Gerry Kelleher and Alison Dingle, shows that we would hit that point in about three to four years' time. We would then have extra capacity to deal with the other parts of the country, if they have not addressed it by then.