Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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I thank the Minister for Health, Deputy Varadkar, for being present to take this matter. Indeed, I acknowledge that he has a good record of attendance to deal with Topical Issues.

There has been some confusion about this matter. I had agreed earlier that we might defer the matter until Tuesday but, apparently, decisions were made elsewhere on the matter. However, I am deeply grateful to the Ceann Comhairle for selecting this topic relating to pancreas transplants.

It was reported last week that the former director of the national pancreas transplant programme has accused Beaumont Hospital of abandoning gravely ill patients on the waiting list. Mr. David Hickey was quoted as saying that the hospital and the HSE were taking an "unethical and callous" approach to patients on the waiting list by seeking to wind up the programme without telling them.

He said, "I hate to see a pancreas programme that has been run well with minimal resources, with patients urgently needing transplants, being squashed because no one gives a damn." Finally, he said that the HSE could find itself facing charges of corporate manslaughter if it failed to provide appropriate levels of care for seriously ill patients. These are extremely serious charges coming from a surgeon who has had an illustrious career.

It would appear that no pancreas transplants have been carried out in Ireland since Mr. Hickey retired last December. Mr. Hickey, who has carried out over 1,500 kidney and pancreas transplants, said he offered to stay on for two years but this was rejected by the hospital. He maintains - it is difficult to disagree - that it is unconscionable that no plan has been made for seriously ill patients four months after his retirement. His retirement date was known for 30 years, but no plans were put in place for that.

It is fair to say that this is a rather bad situation, to put it at its mildest. What does the Minister think? When is it going to be rectified? I appreciate that by the standards of some waiting lists, eight people waiting is not a high number. That was the figure mentioned, although I believe Mr. Hickey has referred to 18 people. Either way, it is not a vast number, but I suspect four months without activity is not a situation the Minister would stand over.

Situating a national transplant programme in a regional hospital was a mistake, Mr. Hickey said. He claimed the hospital was run by people with clipboards who cared only about budgets. I understand that from next month, pancreas transplants are to be carried out at St. Vincent's University Hospital. Moreover, under new arrangements for combined kidney and pancreas transplants, consultants from Beaumont will carry out kidney transplants. However, it is not clear who will carry out the pancreas transplants. Mr. Hickey was trenchant on this matter as well, saying that those in Beaumont had "no idea what they're talking about" in respect of the proposed transfer of services to St. Vincent's. He continued:

You can’t just flick a switch and call it a transplant centre. Who is going to do the work?

Given the critical nature of this particular issue, it is appropriate that we raise it in the House and provide the Minister with an opportunity to address these rather trenchant criticisms. I imagine it is our universal desire to see the problems rectified as a matter of urgency, and I look forward to hearing how the Minister proposes to do just that.

Leo Varadkar (Dublin West, Fine Gael)
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I thank Deputy Ó Fearghaíl for raising this issue and for giving me the opportunity to address the matter in the House.

The national kidney and pancreas transplant programme is currently provided at Beaumont Hospital. In 2014 Beaumont carried out 192 kidney transplants, including 152 from deceased donors and 40 from living donors, as well as six pancreas transplants. The transplant programme at Beaumont Hospital is provided through the surgical specialty of urology. As an aside, this is the first time I have ever heard Beaumont described as a regional hospital. It is recognised as the national centre for neurosurgery and kidney disease as well as many other things. I am surprised to hear someone who worked in Beaumont for so long downgrading the hospital to a regional hospital. It is not; it is a national centre in several specialties. When fully staffed, the urology department in Beaumont has 11 full-time posts. In whole-time equivalent terms, 8.5 of the consultant urologist transplant posts are based in Beaumont, with the remaining 2.5 whole-time equivalent urologist posts based at Connolly Hospital in Blanchardstown. At the end of 2014, two consultant transplant surgeons left the renal and pancreas transplant programme at Beaumont, one on retirement and the second on leave of absence for professional development purposes. Currently, there are three transplant vacancies, which equates to 1.5 in whole-time equivalent posts among the 11 posts - that is, three consultants who would work half time on transplants and half time on urology.

Giving the limited number of surgeons who specialise in transplantation, the filling of vacancies poses a challenge at any time. While Beaumont Hospital is making every effort to recruit suitable people to fill these vacancies, the hospital is also collaborating with St. Vincent's University Hospital on a combined approach to kidney and pancreas transplants. It is now proposed that pancreas transplants, of which six were performed in 2014, will commence in St. Vincent's later this year. While the transfer of this work has been agreed in principle, it will take some time to make the detailed arrangements to facilitate the commencement of pancreas transplants.

Management and clinical staff at the hospital are committed to ensuring that an optimal service is put in place which will benefit all those in need pancreas transplants. Given that St. Vincent's is already established as the national liver transplant centre and the designated centre for pancreas cancer services, this initiative makes sense and will enable two transplant centres to share resources and support and promote improvements in overall transplant services.

There are nine people on the waiting list for pancreas transplants, eight of whom require simultaneous pancreas and kidney transplants. Pancreas transplantation as a stand-alone procedure is relatively uncommon. The arrangements being put in place for simultaneous kidney and pancreas transplants will involve transplant surgeons from St. Vincent's University Hospital and Beaumont working together on the St. Vincent's campus. In addition to working with St. Vincent's on a combined approach to kidney and pancreas transplants, Beaumont is also co-operating on the development of intra-abdominal organ retrieval service that will facilitate a more effective and cohesive overall procurement and transplant service.

I am confident that the measures being put in place will enhance our organ transplant service in future. Six new organ donation nurse managers will be appointed shortly, one to each of the six new hospital groups. This will facilitate the development of the transplant programme over the coming years. Officials from the HSE and my Department are working with senior management and the transparent surgeons at Beaumont and St. Vincent's on the development of transplant services. All parties are committed to ensuring that the transplant programme will be developed to the further benefit of patients.

Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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I appreciate what the Minister has said about what is going to happen in future. It makes sense that there would be a certain level of collaboration between Beaumont and St. Vincent's. However, I do not understand why we have had this hiatus. It has been known for 30 years that this man, the lead surgeon, would retire. Why were plans not put in place in advance of his retirement in order that there could be a seamless transition from the old to the new system? I was a member of the old Eastern Health Board. I admit that during its existence there were significant problems with recruitment and personnel management. To this day there seems to be major problems within the HSE in the area of services and recruiting vital personnel. As I understand it, a pancreas transplant is one of the most complex organ transplants that can be undertaken. The survival rate after five years is of the order of 74%, with a 51% survival rate after 15 years. I recently read that providing a transplant to one person effectively saves the HSE €700,000 over a 15-year period by comparison with the cost of providing that person with dialysis.

This needs to be tackled urgently. People's lives are affected. Moreover, the budget of the health service is being adversely affected. The problem is almost universal within the HSE. I am referring to its inability to effectively manage personnel, forecast where vacancies are going to arise and show initiative and do what those in the private sector would do. It would be unimaginable in any private operation that an impending vacancy would not be filled in such a way as has occurred in this case.

Leo Varadkar (Dublin West, Fine Gael)
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This current issue relates to pancreas transplantation, not kidney transplantation. Dialysis is for kidney treatment and not pancreas problems. The renal unit seems to be working relatively well in Beaumont. Certainly, it has not been the case that any kidneys that could have been transplanted in Ireland were exported or anything like that.

I am not involved in recruitment to individual posts in Beaumont or any other hospital, but I understand the hospital had difficulty filling the post in question. It was advertised and the hospital was unable to get someone. That is an ongoing problem in our health service. What would happen in the private sector is that an organisation would go out and head-hunt someone and pay the person whatever had to be paid, but that is not how the public service works. We do not give market rates to individual people. For various reasons, the public service is different from the private sector in that regard, for better and for worse. Anyway, the important thing now is that the new arrangements are being put in place. It is anticipated that the arrangements will be fully in place within the next couple of weeks.