Seán Kenny (Dublin North East, Labour)
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I thank the Ceann Comhairle for selecting this matter for discussion in the Topical Issue debate. I also thank the Minister for coming into the House to reply to it.

I am raising this issue on behalf of a constituent, Mr. Paddy Mooney, with his consent. He is in his late 70s and on a waiting list for a knee replacement operation at Cappagh hospital since earlier this year. He contacted my office in September and his case illustrates those of many others who have been awaiting hip and knee joint replacement surgery at Cappagh hospital for some time.

I wrote to Cappagh hospital at my constituent's request to find out when he could expect to have the knee replacement procedure carried out. I received the following reply which I will read with the consent of my constituent and the consultant orthopaedic surgeon who wrote it. It is addressed to me and from the department of trauma and orthopaedic surgery, Connolly Hospital, Blanchardstown. It reads:

Dear Mr. Kenny,

Mr. Mooney urgently needs to have a knee replacement at Cappagh hospital. Unfortunately, due to Government policy the financial situation at Cappagh orthopaedic hospital is dire. I am not allowed to do the amount of work that I would like to do, and in fact Cappagh hospital is severely restricted in the amount of operations it can do. In Cappagh we have seven operating theatres. Currently, only two of these operating theatres work per day and, usually only for half a day. Cappagh hospital is functioning to about 15% to 20% of its capacity.

If you can arrange through your contacts in government to alleviate this situation, I would be glad to be able to get Mr. Mooney's operation done much quicker. Currently, there are over 200 patients on my waiting list for joint replacement surgery, meaning that my waiting list is well over a year.

Yours Sincerely,

Mr. Paddy Kenny, consultant orthopaedic surgeon.

I subsequently spoke by telephone to Mr. Kenny who reaffirmed the contents of his letter. He later took part in a radio programme, "Liveline" with Joe Duffy, on 10October. On air, he described the situation at Cappagh hospital, where on a day-to-day basis usually only two of the seven operating theatres were in use, although he maintained there were enough consultants available to ensure all seven could be fully utilised. He went on to say 24 orthopaedic surgeons were available in the hospital but asserted that owing to a lack of finance sufficient nursing staff were not available to operate all seven operating theatres on a daily basis. He added that hip and knee implants cost on average between €1,800 and €2,000 per implant. He further stated he personally could carry out four to five implant procedures per day if he had the resources to do so and added that he had 198 patients on his waiting list and that the waiting time was 15 months.

A number of listeners telephoned the programme on the day to describe their situation and the level of pain they were enduring while awaiting a hip or knee operation. I have personal experience, as I had to undergo a knee replacement operation some years ago. Accordingly, I can empathise with others in the same position. I was lucky enough to have health insurance and able to have the procedure carried out within a couple of months. I can only imagine the pain a person must endure if they have to wait for 15 months.

I understand the HSE service plan for 2015 was launched today. I will be pleased to learn from the Minister if the situation at Cappagh hospital will be addressed in 2015.

Leo Varadkar (Dublin West, Fine Gael)
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Long ago when I was involved in clinical practice, I used to take great pleasure in writing such letters to politicians, including to the former Taoiseach, one Bertie Ahern. I am pleased to see the practice has not been discontinued. I thank the Deputy for raising the issue and for giving me an opportunity to outline to the House the current position on it.

Cappagh National Orthopaedic Hospital is a major elective orthopaedic facility which provides a national secondary and tertiary referral service for orthopaedic care for adults and children, including the national bone tumour surgical service. There has been a significant increase, 40%, in the number of referrals to Cappagh hospital this year. The level of increase has not been observed at other sites and the factors for the increase in referrals are being investigated.

I had the opportunity to meet representatives of Cappagh hospital yesterday, including the CEO, the chairman, the medical secretary and the medical director, and hear from them first-hand about the challenges faced by the hospital this year. The cumulative effect of a reduced orthopaedic revenue allocation, the cessation of National Treatment Purchase Fund, NTPF, funding and a reduction in private insurance income in 2014 has limited the surgical capability.

Cappagh hospital has a total of seven operating theatres. However, while there are sufficient consultant staff available to provide services to meet demand requirements, not all theatres have been in use in 2014. As the Deputy outlined, between two and four theatres have been in use. This is a factor of both the need to manage activity levels within the financial capability and the availability of suitably qualified theatre nursing staff.

In terms of access, urgent patients continue to be prioritised and Cappagh hospital has advised that owing to strict chronological booking policies, all patients attending the hospital are being offered dates for surgery based on their waiting time for surgery having due regard to clinical categorisation.

The HSE has been in active engagement with Cappagh hospital this year regarding its finances and to examine and agree options for optimising the available theatre resources and to ensure patients have timely access. The HSE recently facilitated €800,000 in additional funding to enable Cappagh hospital to treat 102 patients from the waiting list in Cavan General Hospital. This will also facilitate treatment for some additional Cappagh hospital patients. Funding has also been provided this year for 43 active rehabilitation beds at Cappagh and I understand this initiative has worked very well.

I have also been advised that, while challenges remain in relation to inpatient access targets, day case and outpatient 2014 target levels will be achieved this year. For 2015, I understand the HSE will continue to engage with the hospital regarding its budget and to explore mechanisms to ensure optimal use of resources, including theatre capacity, at the hospital within the overall resources available to the acute sector.

The Deputy will also be aware that Cappagh hospital is part of the Ireland East hospital group, which includes the Mater; St. Vincent's University Hospital; Midland Regional Hospital, Mullingar; St. Luke's Hospital, Kilkenny; Wexford General Hospital; National Maternity Hospital, Holles Street; Our Lady's Hospital, Navan; St Columcille's Hospital; St Michael's Hospital, Dún Laoghaire; and the Royal Victoria Eye and Ear Hospital.

I am confident there will be a structured integration of Cappagh hospital into the Ireland East hospital group in 2015 and that this will provide opportunities and support for Cappagh hospital in managing demand and delivering high quality, safe patient care in a cost-effective manner.

Seán Kenny (Dublin North East, Labour)
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I thank the Minister. I note the Minister used to write letters similar to that written by Mr. Paddy Kenny. I note the Minister's hope that a re-organisation of the hospital system will produce a better result. However, the people on the waiting list tend to be older people who need knee and hip replacement surgery. If they have to be on a waiting list for more than a year they will be suffering from pain and trauma. My constituent tells me that he has difficulty walking to the shops and his condition is getting worse. A person should not have to endure that kind of pain in their older years. Such cases should be prioritised.

Is there a particular problem in Cappagh hospital not replicated anywhere else? If such a problem can be addressed would it mean that the waiting time of 15 months could be reduced? The Minister referred to other hospitals in his reply. Would it be possible to send patients to another hospital for the same orthopaedic surgery? Is that an option for patients?

Leo Varadkar (Dublin West, Fine Gael)
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There is not a particular problem in Cappagh hospital. It is a very well run and well managed hospital. Ironically, in some ways the hospital demonstrates the consequences of coming in on budget. The hospital does not have an accident and emergency department and therefore, no emergency admissions and as a result the hospital can plan its activities precisely every year. The hospital has come in on budget every year and it has almost no agency staff. However, the consequence is that the hospital has had to cut back activity very considerably and this is the cause of the problem highlighted by the Deputy.

In the HSE service plan published earlier today provision is made for an increase in the number of day cases and day surgery by 20,000 next year. It is intended within the budget of €4 billion for hospitals to provide an increase in the budget for Cappagh hospital next year so it can begin to ramp up activity. It is hoped this will show results next year in terms of people like the Deputy's constituent and many of mine experiencing shorter waiting lists. The difficulty we have is that as our population ages, the demand for orthopaedic surgery keeps increasing and the budget is not increasing adequately to meet that demand. The situation will be alleviated next year when there will be more money for Cappagh hospital to carry out these operations, but not enough unfortunately.