Dáil debates

Thursday, 21 March 2013

Topical Issue Debate

Access to Health Services

3:35 pm

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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I thank the Ceann Comhairle and his office for allowing us to raise this issue and thank Senator Trevor Ó Clochartaigh, who organised a briefing by Mr. Sherif Sultan, the vascular surgeon at University College Hospital Galway and the Galway Clinic, on this topic yesterday. It is not even a funding issue. Someone just needs to take responsibility in the three counties of Galway, Mayo and Roscommon for deciding who pays for this machine.

The arterial assist machine increases arterial blood flow to the leg, and 550 patients in Ireland currently use it. None of these patients is in the three counties I mentioned because of a disagreement between different units of the HSE on who funds this. To rent one of these machines for 90 days costs €1,200 and it can save a leg from amputation. It is for people with severe vascular conditions in their legs who, if their condition deteriorated, might need to have the leg amputated, with all of the associated social, personal and financial costs. There are 127 patients on a waiting list and an ArtAssist machine for those 127 patients would cost less than half the cost of seven amputations.

In University College Hospital Galway, I could be in the room next to the Minister of State but because I am from Mayo I would not get the machine while someone who lives five miles up the road in Sligo would get it. It is ridiculous. I do not know if it is a funding issue but heads must be knocked together to make this service available to the patients in those three counties.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Independent)
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I also thank the Ceann Comhairle for giving us the opportunity to raise this issue. Mary is an example of someone on this waiting list. She is 46 years of age with three young children. She suffers from leukemia and her medication has a detrimental impact on the blood circulation in her legs. She is about to undergo bypass surgery as a last resort to save her left leg. She now urgently requires the ArtAssist pump on her right leg but because it costs €1,100 for 90 days, which she cannot afford because she is a medical card patient, the local authority must rehouse her because she lives in a two storey, three bedroom house. The frustrating thing for Mary is that she lives in north Roscommon, about five miles from the Sligo county boundary, and if she lived on the other side of that boundary, she would not have any problem getting this. Not only would it save her leg, the local authority would not have to construct a purpose built house to cater for her and her young family.

It is frustrating that an anomaly exists within the system in Galway, Roscommon and Mayo that means there is no funding while in other parts of the country that is not the case. As Deputy Calleary pointed out, it is unclear who is responsible and who should pick up the bill.

Photo of Alex WhiteAlex White (Dublin South, Labour)
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The budget provision for 2013 represents a major challenge to the Health Service Executive and comes at a time of significant reform of the public health system. The gross current voted Estimate for the HSE is €13.4041 billion. Although there is a net increase of €71.5 million on 2012, as the HSE faces unavoidable spending pressures of €748 million, expenditure savings of €721 million will be required to remain within budget in 2013.

Under the Health Act 2004, the Health Service Executive must prepare a service plan and submit it to the Minister for Health for approval following publication of the Estimates. The national service plan which was submitted in December 2012 sets out the quantum and type of health services to be provided in 2013 within the overall level of funding provided. In accordance with the Act, the Minister for Health approved the national service plan and laid a copy of the plan before both Houses of the Oireachtas on 9 January this year. Subsequently, the HSE prepared and published its operational plan and regional service plans which underpin the national service plan at the end of February.

There is provision for expenditure at local level for the purchase and use of goods in local integrated service areas. These are referred to within the HSE as "local schemes" and the device in question would fall within this category.

The HSE has responsibility for the delivery of services set out in these regional plans and to ensure services are delivered within budget. As such it is not a matter for the Minister to issue a direction regarding specific items of expenditure. However, I appreciate the Deputy's concerns and have made inquiries concerning this matter. I have been advised that the provision of ArtAssist pumps in Galway and Roscommon has been discontinued pending the outcome of a review of their efficacy. The national clinical care programmes office has been requested to carry out this review.

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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After that, my own and Deputy Naughten's remarks still hold. There is a ridiculous anomaly that someone a mile inside a county border can get the machine while someone a mile on the other side is in the wrong county and cannot get it. I will raise this at my HSE meeting in Castlebar, and the Galway Deputies will be raising it tomorrow. It would be good if the Minister of State, Deputy White, could give some commitment because, as the Minister with responsibility for primary care, it would make his job easier. He mentioned budgetary issues. It is clear the availability of this machine will save money in the short, medium and long term, not just in the Department of Health but also in the Department of the Environment, Community and Local Government and in local authorities. That silly anomaly must be addressed for the sake of all concerned.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Independent)
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I thank the Minister of State for his response. The most bizarre aspect of that response was the comment that the Galway-Roscommon NCCP office is looking at the efficacy of this pump. Mr. Sultan, the head of the Western Vascular Institute, has published peer review studies on this equipment and an analysis of the 127 patients on the waiting list showed it is five and a half times cheaper to use the ArtAssist pump than to treat people conventionally. Of those treated with this equipment, 94% will save their legs. Even purely from a social point of view, the efficacy has been proven, along with peer reviewed research. I find it bizarre the HSE wants to carry out its own review.

Photo of Alex WhiteAlex White (Dublin South, Labour)
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I take the points made by both Deputies. On Deputy Calleary's remark on the desirability and necessity for consistency, I would be concerned about this and when I have an opportunity, I would like to find out more about it. It would not make sense if there was an inconsistency across the country for any service.

I would not regard it, however, as bizarre that we should have a system in place for determining the efficacy of devices, procedures or drugs. I am sure the practitioner concerned is eminent and has carried out the studies referred to by Deputy Naughten and serious regard should be had to them. I hold the view, however, that we have a system in place that makes determination on efficacy and appropriateness of devices and medication across the system and we should rely on that.

I cannot say any more than I already have. There is an inquiry being carried out by the national clinic care programme on this but I have taken on board the remarks made by the Deputies.