Dáil debates

Thursday, 21 July 2016

Topical Issue Debate

Hospital Procedures

4:30 pm

Photo of Jack ChambersJack Chambers (Dublin West, Fianna Fail)
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I am raising a matter which I consider to be extremely important and which impacts on patients who are waiting for a cardiac procedure called a transcatheter aortic valve replacement. This procedure involves the replacement of an aortic valve in a less interventionist way than by means of open heart surgery. The aortic valve is replaced by a cardiologist rather than a cardiac surgeon. The valve is replaced through a femoral or other artery instead of via open heart surgery, as I have stated. The reason patients require this type of cardiac intervention is that open heart surgery has been medically assessed as being inappropriate due to the underlying medical conditions of the patients involved. For example, some of them have quite severe cerebrovascular disease, renal disease, arterial disease, underlying respiratory issues or even haematological issues. They cannot get the required treatment via open heart surgery, which was the historic means to make a cardiac intervention. That is impossible for many patients.

This transcatheter aortic valve is the solution for the patients in question. Many of them, as I have discovered through constituency representations, are not getting the intervention they need and deserve. The situation, as it currently stands, at the Mater Hospital is an illustration of total and complete management dysfunction. It is an illustration of the complete dysfunction of the Ireland east hospital group and the short-sighted, irrational and clinically dangerous allocation of resources within our health service.

The information I have received is that there are up to 18 patients who are clinically unwell and sick. They are not clinically able for open heart surgery. They are assessed as needing this valve replacement in the Mater Hospital. They have complex medical and cardiac needs and time is absolutely of the essence. The barrier, however, to them getting their required intervention is not a staffing issue, an issue with theatres or an issue of bed capacity. We have the doctors, the nurses, the theatres, the hospital and the beds. We do not have one thing: the State, the HSE, the Department of Health and the Ministers will not provide funding for more than two valves per month. The consequence of that for many patients is that they are becoming clinically unwell and sicker. Their lives are at risk as a result of an unfair management practice.

The HSE - and, by extension, the Department and its Ministers - is refusing to fund more than two of these procedures per month within the hospital is because of the cost of the valve. Patients are left lingering for months, with their lives at risk and their health deteriorating. A rigorous, irrational and completely unreasonable budgetary approach to transcatherter aortic valves means that medical and health teams that are already in place cannot make the intervention they are paid to make. Why? It is because neither the Ministers nor the HSE, as the service provider, will provide funding for the necessary equipment. As a consequence, many of these patients are in our hospitals being managed medically because their underlying symptoms are worsening and they cannot get the valve. It is the most unreasonable and irrational method of allocating funds. I accept that the valve costs more than open heart surgery. However, it is regressive, in the context of our health policy, to limit the quantity of valves when we have the teams in place. We have spoken about recruitment issues in our health service. That is not an issue in this case. The staff are there to perform the procedures and have been telling the patients that they will perform them. They have the theatres but the HSE will not provide funding. I urge the Minister of State to address this issue.

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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I am taking this matter on behalf of my colleague, the Minister for Health, Deputy Simon Harris, who has asked me to extend his apologies to the Deputy as he is unavoidably occupied elsewhere. The debate gives me the opportunity to update the House on the transcatheter aortic valve implant, TAVI, procedures at the Mater Misericordiae University Hospital, as raised by Deputy Chambers.

Aortic stenosis is the most prevalent valvular heart disease and the third most common cardiovascular condition after coronary artery disease and hypertension. Many patients with advanced aortic valve disease are too high a risk for traditional treatment, such as open chest surgery, due to advanced age or co-existing medical conditions. Catheter-based techniques such as TAVI are, therefore, hugely important as they provide an alternative method for treating aortic stenosis in patients with unacceptably high surgical risks. TAVI procedures are a relatively new development in Ireland, with the first case performed in 2008. In addition to the Mater, TAVI services are now provided at St. James’s Hospital, Galway University Hospital and Cork University Hospital.

I understand that funding arrangements to date facilitate a limited number of these procedures to be undertaken each year. The HSE has advised that, so far in 2016, at least 19 TAVI procedures have been completed at the Mater. The HSE has also told me that the Mater manages waiting lists with due regard to the complexity and urgency of the cases presented. Further development of the TAVI service will need to be considered as part of the 2017 estimates process now underway, in the context of overall competing priorities and demands for health service funding.

In the context of waiting lists for this service and for all health services, I wish to emphasise that improving waiting lists for scheduled care is a key priority for the Government. The emphasis in the programme for a partnership Government on the need for sustained commitment and funding to improve waiting times for patients is evidence of this. However, I am aware that waiting list data for June 2016 shows that the numbers of those on lists increased nationally in the first half of the year. The Minister, Deputy Harris, met the HSE national director for acute hospitals on Friday last, 15 July, regarding proposed measures to tackle waiting lists. He has asked the HSE to submit an action plan setting out the specific measures it proposes to implement with hospitals within current resources between now and the end of 2016 in order to achieve tangible improvements in waiting list management. The action plan will focus on measures to improve hospitals' processes in managing waiting lists, to validate all waiting lists and to target the specialties and hospitals with the highest numbers of patients waiting. I want to emphasise the Government’s determination to address undue waiting times for all those in need of our health services, including TAVI procedures, and I am confident that good and steady progress on waiting lists overall can be achieved in the months ahead.

Photo of Jack ChambersJack Chambers (Dublin West, Fianna Fail)
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I thank the Minister of State for the response. She has reiterated what I told her about the issue around aortic stenosis and the medical complexities involved. She then mentioned how the Government funds some of the procedures and how there is limited funding for them. Finally, she provided a summary from some manager about what they are apparently doing to address the numbers on waiting list numbers, which have rocketed this year. She did not address the specific question around these TAVI procedures at the Mater Hospital. That was all management lingo. She spoke about the 2017 Estimates. That will do nothing for the 18 patients who are waiting today for this procedure. They do not have the six months to the end of the year to survive. That is being realistic about it. She has given no commitment to address the current chronic issue of not funding the piece of equipment needed.

Let me give an example. There is one patient in my constituency who has been in the Mater Hospital for a month. The cost of a bed is €1,000 per day. He is going to be there for more than two months. That could equate to a cost of €60,000 to the State. The valve costs €22,000 and there are negligible staff costs because we already fund them. The problem we have in this health service is that we see the bed capacity issue as a fixed cost. He can stay in the bed. Managers are not necessarily concerned with his medical outcome because if he gets the clinical outcome and procedure, someone else will replace him.

There is no incentive within management to see clinical progress for patients and to cut the waiting list. They do not care whether he is in the bed any longer, because they have left him there and have focused on the estimates and the costs. The clinical outcome could be much improved for him and for others if they were given the valve and the procedure. They then would be discharged from the beds for the benefit of someone else. Instead, he is being left in the bed, which is a cost to the State, to the detriment of his health and to the detriment of the health service overall. The 2017 Estimates and the management lingo about what the Government is doing regarding action plans about waiting times is nonsense. It will not address this specific issue in the Mater Hospital, which is rigid and irrational management procedure regarding the funding of a basic piece of equipment when all the additional costs already are being funded. The Government must tackle management to stop this and I urge the Minister of State to do it now.

4:40 pm

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank Deputy Jack Chambers. The extent to which he is exercised by this important topic is evident. I also am exercised and any Minister in the Department of Health obviously would like to see the €14 billion of taxpayers' money allocated to the Health Service Executive, HSE, is being well spent. This is why the Government is taking waiting lists, including this particular one, so seriously. The Minister, Deputy Harris, and the Department are engaging with the HSE to establish how these waiting lists can be reduced. It is interesting to see the kind of numbers that are being dealt with overall. For example, there are 3.2 million outpatient attendances at hospitals.

Photo of Jack ChambersJack Chambers (Dublin West, Fianna Fail)
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That has nothing to do with what I am asking the Minister of State.

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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It is, however, part of the overall picture of waiting lists.

Photo of Jack ChambersJack Chambers (Dublin West, Fianna Fail)
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It is not what I want. I seek a specific picture.

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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I would like an opportunity to respond. Deputy Chambers, you are a new Deputy and I thought the least you would do is afford somebody the opportunity to answer-----

Photo of Robert TroyRobert Troy (Longford-Westmeath, Fianna Fail)
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Through the Chair please. The Minister of State, without interruption.

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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Yes. I thought Deputy Chambers might also afford me the courtesy of speaking through the Chair-----

Photo of Robert TroyRobert Troy (Longford-Westmeath, Fianna Fail)
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I have asked for the Minister of State to be allowed reply without interruption.

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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-----which would be very helpful.

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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Hear, hear.

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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The Deputy's behaviour has not changed since the very first time I encountered him in the Chamber, when I was in the Acting Chairman's position. In any case, there would be no harm in doing a little bit of an induction course for some of them.

Photo of Jack ChambersJack Chambers (Dublin West, Fianna Fail)
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Would you learn to answer questions?

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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The overall budget of the HSE is €14 billion and while the Deputy alleged it was not being funded adequately, it has received an increase in its budget of a further €500 million, which was approved just last week. Yes, there certainly is something wrong with what is happening in the management of waiting lists and we all want to get to the bottom of it. The Deputy is not the only person who cares about this and I reiterate the Government is taking this matter extremely seriously. Not only are there waiting lists in the Mater Hospital but there are others elsewhere the Government also wishes to address. However, it should be given the opportunity because one should remember the party of which the Deputy is a member caused the financial crash-----

Photo of Jack ChambersJack Chambers (Dublin West, Fianna Fail)
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Answer the question.

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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----- which put us into the financial mess we are in.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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That was unfair.

Photo of Jack ChambersJack Chambers (Dublin West, Fianna Fail)
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Answer the question.

Photo of Robert TroyRobert Troy (Longford-Westmeath, Fianna Fail)
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The Minister of State, without interruption.

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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We are now trying to come out of it-----

Photo of Jack ChambersJack Chambers (Dublin West, Fianna Fail)
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She is not answering the question.

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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-----and do a good job to give back to-----

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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Offside.

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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-----the people the type of health service they deserve.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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The Minister of State made it personal; there was no need.

Photo of Robert TroyRobert Troy (Longford-Westmeath, Fianna Fail)
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I thank the Minister of State. Everyone's nerves are getting frayed towards the end of the session, of which only another hour or two remains.