Paul Connaughton Snr (Galway East, Fine Gael)
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I am thankful to be given this opportunity in Dáil Éireann to raise a very important matter concerning a patient in County Galway who was due to undergo an operation last week in St. Vincent's public hospital in Dublin for the insertion of a special implant known as a spinal pain block to try to lower the most intensive pain that emanates from his back. He was told hospital management at St. Vincent's had decided a few days earlier that it had established a new catchment area, consisting in the main of Dublin city and County Wicklow. For all other patients coming from outside this area the local HSE or the actual patients would have to bear the cost of the operation - in this case €26,000.

This is in spite of the fact that this operation cannot be performed in any other hospital in the country. St. Vincent's Hospital treated patients from all over Ireland until last week. Both the hospital and HSE west are funded from the same HSE purse nationally so this is no more than a tug of war match between two parts of the HSE. The only loser is an elderly patient in County Galway lying on the broad of his back with excruciating pain.

Whoever can knock heads together tomorrow morning, or however it may be done, it cannot be possible, in natural justice, that any person, in particular, any elderly person, should be subject to the treatment this poor man is receiving. I do not know the reason St. Vincent's Hospital has made this decision. I assume it has problems with its budget just as HSE west has problems but neither has the problems of the patient of whom I speak.

I hope the Minister of State will bring this matter to the notice of the Minister, Deputy Harney, tomorrow. Whatever may be done tomorrow, in the name of the Lord I ask that they try to get this man taken into hospital. Granted that even with this procedure the prognosis is not for 100% success, anything would be better than what he has been putting up with for the past ten years. I use whatever words I can to convey to the House that if ever there was an urgent matter regarding a sick patient I am speaking about it now. I have the medical evidence to prove it and all I ask is for the Minister of State to convey to the Minister for Health and Children that something must be done for this patient.

Seán Haughey (Dublin North Central, Fianna Fail)
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I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. The management of chronic pain is a highly complex and specialised area of medicine, requiring a multidisciplinary approach to treatment and care of patients. Traditionally within Ireland and the UK, pain medicine evolved from within the hospital discipline of anaesthesia and is a consultant-led service. The service has grown considerably in this country over the last two decades and departments of pain medicine now exist in most regions.

Patients requiring treatment for chronic pain can be seen in a number of different settings. Most patients are treated on an out-patient basis at major acute hospitals and return home after treatment. Where required, patients are also treated on a day-care or in-patient basis under a more intensive and structured treatment programme. The department of pain medicine at St Vincent's University Hospital is the largest centre in Ireland providing treatment for chronic pain. The service was founded in the hospital in 1991 and has continued to develop its expertise in this area since then.

St. Vincent's University Hospital provides one of the comprehensive pain management services in Ireland. While it is not a national referral centre for pain management, the hospital has accepted on its waiting list patients from all over the country. These patients are referred to St Vincent's by pain medicine consultants in other institutions. This is because of the need for particular expertise and a multidisciplinary approach.

Patients are prioritised and treated by the consultants based on clinical need. All patients at initial evaluation are assessed by a multi-disciplinary team comprising a pain specialist, a clinical psychologist and a physiotherapist. All patients complete a range of psychometric evaluation tools prior to assessment in order to help identify the psychological impact of pain on each individual. Following evaluation an individualised management plan is devised for each patient comprising medication optimisation, diagnostic procedures, psychological intervention, functional rehabilitation, including physiotherapy and occupational therapy and interventional therapies.

Approximately 150 major implants per year are performed in St Vincent's Hospital including spinal cord stimulation. This accounted for over 80% of all such major interventions performed in Ireland in 2007. It would not be appropriate for me to comment on a particular case. However the HSE has assured the Minister that patients when referred to the service will continue to be prioritised on the basis of clinical need. This priority list is regularly updated.

Although HSE west provides certain treatments for chronic pain management it does not provide some of the more complex treatments available at St Vincent's University Hospital. HSE west refers its more complex cases to St Vincent's and sometimes to the Mater or Beaumont hospitals in Dublin. The HSE is exploring whether further treatments could safely and appropriately be provided in the western region. The Minister has been assured by the HSE that all patients already on the waiting list at St. Vincent's Hospital will be appropriately prioritised and treated on the basis of their clinical needs. It is important that a co-ordinated approach to the management of patients with severe and chronic pain is ensured in order that patients who require treatment can receive it as quickly as possible in the appropriate healthcare setting. The Minister has asked the HSE to address this issue as a matter of priority.