Stephen Donnelly (Wicklow, Social Democrats) | Oireachtas source

We are debating whether to sign off on an additional €500 million for the health budget, an issue I will address alongside the lack of an analysis provided for the Dáil on same. While we are discussing health services that need more funding urgently, I wish to raise a particular matter, that of Cappagh National Orthopaedic Hospital, about which a constituent of mine contacted me in recent weeks. She needs a hip replacement, is in severe pain and her condition is deteriorating. She is on her way to being in a wheelchair, something I have had confirmed by her surgeon. She was told that she would have to wait 15 months.

When I looked further into what was happening at Cappagh hospital, what I discovered was disturbing. If a general practitioner, GP, believes someone in the greater Dublin area needs orthopaedic surgery, or if anyone in the country needs complex orthopaedic surgery, it will take 15 months to see a consultant. It will take a further 15 months to get into an operating theatre. As such, it takes two and a half years to get from a GP to the operating theatre. In the United Kingdom it takes four months and i New Zealand, three.

I have spoken to surgeons in this field. To say they are demoralised, frustrated and angry would be a gross understatement. Anyone who attends a GP and needs orthopaedic work, be it on a hip or a knee, is typically already in serious pain. In the two and a half years someone will wait for surgery, the pain will escalate, the person's condition will deteriorates and the complexity, cost and recovery time of the operation will move in the wrong direction, as will the clinical outcomes.

I will explain what is happening in Cappagh hospital and why people in Ireland are waiting two and a half years for a hip operation. By the way, if someone needs the other hip or knee to be operated on, he or she must go back to the start of the list. Compare this with the figure of 12 weeks in New Zealand and 16 across the water in the United Kingdom. In 2014 Cappagh hospital suffered a serious cut in Government funding, which meant that it needed to reduce the number of procedures it could carry out that year by 700. It let staff go and scaled down. In 2015 the situation was so bad that the Government increased its funding. Last year Cappagh hospital started to scale up again, but it incurred higher costs by hiring agency staff because it did not want to have to fire anyone again. At the start of this year the HSE could not tell the hospital how much money it would be given for the year. For the first three months it operated on the understanding that it would have the same budget as last year. After the first quarter, however, it discovered that it would suffer a further cut in funding. It must let staff go and scale back again.

There are six operating theatres in Cappagh hospital, only three of which are being used. Typically, an orthopaedic surgeon can perform five procedures in an operating theatre on a given day. The surgeons in Cappagh hospital have been instructed to stop after three. The State is paying all of the hospital's fixed costs - for the six operating theatres, the wards, the beds that are not being used, the theatre staff and the surgeons - but the hospital no longer has money for implants which typically cost between €1,500 and €3,000 each. For a complex operation, it might cost up to €6,000 and, obviously, the cost increases. I told the patients that, were my relative affected, I would borrow the money to buy an implant on eBay and bring it to the hospital, but when I asked them about doing this, they said they were not allowed to do so. When I asked the surgeons what they did after performing the three procedures, they told me that they went home or into private practice where they could actually treat patients.

Since the Minister, Deputy Harris, had to leave the Chamber, I ask the Ministers of State who are present, Deputies Helen McEntee and Finian McGrath, to raise as a matter of urgency the fact that, owing to Government cuts, Cappagh National Orthopaedic Hospital has not got the money for the implants needed for patients who have been waiting for two and a half years for orthopaedic surgery. However, the problem is even worse because, as I found out, the target of being admitted to an operating theatre within 15 months of meeting a consultant is a HSE target. Cappagh National Orthopaedic Hospital will now miss the targets. The HSE will, therefore, fine it and it will have less money for implants. The waiting lists will get longer and the HSE will fine the hospital again. That is happening right now in our national orthopaedic hospital. If we are to have a conversation about a budget of €13.7 billion and additional expenditure this year of €500 million, the Minister should, as a matter of urgency, engage with Cappagh hospital. It needs approximately €5 million or €6 million for the rest of the year.

Cappagh National Orthopaedic Hospital also needs multi-annual funding. I cannot understand why this is not made available. Imagine a hospital not knowing in the first three months of the year how much funding it will have for the year. Other organisations just do not operate like that. The hospital needs funding for this year, and it needs multi-annual funding. It needs more ambitious targets. It is unacceptable that the HSE target for orthopaedics is 15 months. This period needs to be reduced.

There is no load balancing across the hospitals. Thus, the waiting lists in Limerick are much smaller than in Dublin. There is no national patient database. There is no co-ordinating function whereby one would be asked whether, on the basis that one must wait 15 months in Dublin, one would be willing to wait six months on a list in Limerick. There is no load balancing in this regard at all. I will send the Minister the notes on this. Will he please consider providing a low number of millions of euro to Cappagh National Orthopaedic Hospital? I will be more than happy to send him all the details.

What is happening in Cappagh, including the mismanagement by the health care system of the funding for the hospital and the results for patients and the medical staff, is symptomatic of a Health Service Executive that clearly does not know how to run budgets. The Government is asking the Dáil to sanction an additional €500 million. To put that in perspective, that is more than half the total fiscal space we will be debating in October for the entire budget for next year. An extra €0.5 billion — over half the entire budgetary space for next year — is being sought by the Government. I apologise if the analysis is unavailable. I have tried to obtain it. We have contacted the Minister’s office and looked at the website of the Department of Health but I cannot find any breakdown of the €500 million. I have read through the Minister’s speech and have found explanations for allocations of €40 million here, €50 million there and €15 million in other places.

I have to hand the revised book of Estimates. It gives the revised budget for this year, €13.69 billion, but nowhere is it explained where the extra €500 million has come from. There are references to some allocations in the Minister's speech but I cannot find a table indicating how the €500 million breaks down. There is €200 million for additional services and €300 million for overruns. It ought to be stated that the €200 million for additional services is going to listed places based on certain cost–benefit analyses.

The Dáil voting through an extra €0.5 billion is a massive undertaking but we are not being provided with the kind of analysis one would expect to see if asked to sign a cheque for €0.5 billion unexpectedly. I apologise if we were provided with it. This debate is about whether the Dáil is willing to sign a cheque for the HSE of an additional €500 million. Now that the committees are being formed, surely the Minister should offer an explanation of the allocation and the overruns to the health committee, finance committee or the new budgetary committee.

The Minister mentioned in his speech the new accountability framework that the HSE is putting together. It is very welcome to see an accountability framework coming together. If in my pre-politics world people said they had overspent by €0.5 billion, there would have been serious accountability. I am not talking about the Minister as he is new in the job; I am talking about the HSE. Has anyone been fired? Has anyone been demoted? Someone, somewhere, has overspent by hundreds of millions of euro. Will the accountability framework actually hold anyone to account for over-expenditure of hundreds of millions of euro?

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