Dáil debates

Thursday, 29 April 2021

Saincheisteanna Tráthúla - Topical Issue Debate

Hospital Facilities

8:10 pm

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank the Ceann Comhairle very much for giving us the opportunity to discuss this very important issue. The National Orthopaedic Hospital Cappagh treats patients from all over our country for a broad range of orthopaedic conditions. The hospital has worked very hard over the years to improve access to treatment and to increase patient numbers. In Cavan-Monaghan and the neighbouring counties, there are many patients of all ages who are on long orthopaedic waiting lists. In many instances, people are in pain and immobile. These waiting lists are not acceptable.

I know from speaking to patients and people who have supported the hospital in Cappagh over the years, that it has the space to facilitate the provision of much-needed additional theatre and bed capacity. I understand that detailed and costed proposals are with the Department and the HSE. If implemented, these plans could be transformative for orthopaedic care nationally. In addition to new accommodation, some existing accommodation needs to be replaced. There are also additional requirements arising from Covid. The changing demographics in our country have also increased pressure on orthopaedic provision.

I have a particular interest in the hospital in Cappagh as I had an operation on my back there years ago. I am forever grateful for the treatment and care I received at that time. I know that many other patients of the hospital are very conscious of how excellent the care they get within it is. That is the message I have received constantly over the years from people who have attended the hospital in Cappagh.

It is heartbreaking to see children and teenagers immobile and in pain due to not getting appropriate treatment and surgical intervention.

In this day and age, that is not acceptable. I know of young people who are in dire need of orthopaedic surgery yet are on long waiting lists. In the meantime, their conditions continue to deteriorate. The State has an obligation to ensure that no child is denied unduly the treatment and surgery he or she needs.

8:20 pm

Photo of Jackie CahillJackie Cahill (Tipperary, Fianna Fail)
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I thank the Ceann Comhairle for picking this Topical Issue and giving us an opportunity to discuss it, and I thank the Minister of State, Deputy Rabbitte, for attending.

I visited Cappagh hospital earlier this week and received a briefing from its chief executive, Ms Angela Lee, and one of its surgeons, Mr. Connor Green. Its excellence, capacity, figures and results are phenomenal but it is an old-style structure and there are issues with meeting HIQA's standards. Its high-dependency unit greatly restricts its capacity to operate its five theatres.

The hospital has three key demands: a new ten-bed high-dependency unit; 76 single occupancy rooms; and three additional operating theatres. If this infrastructure is put in place, we will have a great opportunity nationally to reduce waiting lists. Each of us has many people in our constituencies who are constantly contacting our constituency offices trying to get orthopaedic operations done. It is particularly galling to see young people waiting long periods for essential surgery.

The hospital has a 30-acre site. I will not raise the issue of the children's hospital or the long debate on same, but the hospital in Cappagh has the room for this new infrastructure. It believes it can double the number of surgeries it performs if this investment is made. As Deputy Brendan Smith stated, the hospital has produced detailed figures, which are with the Department of Health now. In a modern context, the contribution it is seeking from the Exchequer is not significant. For an investment of €34.5 million, it could provide this infrastructure, although that would only be for the building itself and would exclude VAT and professional fees, for example, architects' fees. It has had detailed discussions on financing the development through a public-private partnership.

The hospital's executive has put serious work into this plan and, for an investment that would be minimal in terms of the health budget, there is an opportunity to increase capacity in the orthopaedic sector greatly. The hospital has the will and capacity to do it.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputies for submitting this Topical Issue, which I am responding to on behalf of the Minister, Deputy Stephen Donnelly, and giving me the opportunity to provide an update to the House on waiting lists in National Orthopaedic Hospital Cappagh.

Regarding paediatric orthopaedic waiting times, there has been an increased investment in paediatric orthopaedics and scoliosis services in recent years, which has improved access to surgery and outpatient appointments. In 2018, Children's Health Ireland, CHI, was provided with an additional €9 million to address paediatric orthopaedic waiting lists, including the provision of scoliosis services. This funding supported the recruitment of approximately 60 whole-time equivalents in 2018 and 2019 to enable the expansion of paediatric orthopaedic services, including scoliosis services. The posts related to multidisciplinary teams at diagnosis, pre-assessment, during surgery in theatre and post-operative care.

In general, waiting times for scheduled appointments and procedures have been impacted in the past year as a direct result of the Covid-19 pandemic. Elective hospital care was further curtailed for the first quarter of 2021 in line with the rapid increase in Covid-19 hospital admissions, with only critical time-dependent elective procedures undertaken. This has affected activity in CHI.

Regarding orthopaedics, I am advised that Children's Health Ireland is expanding its activity in Cappagh hospital and is also running additional orthopaedic clinics in Citywest using a new active clinical triage model that is reducing the number of children waiting the longest for appointments. Children's Health Ireland proactively continues to work with the HSE and my Department to reduce waiting times for patients attending the scoliosis service.

I am advised that funding has been provided for additional paediatric orthopaedic clinics at Cappagh orthopaedic hospital and that additional outpatient clinics commenced on the 17 February. I am further advised that additional theatre capacity for day case surgery at Cappagh commenced on 26 April, which should have a significant positive impact through reducing long waiting times for general orthopaedic patients in addition to scoliosis patients.

The Deputies might wish to note that, in January, the HSE added for development a €1.65 million project of an outpatient paediatric clinic to the capital programme, which will be considered for progression subject to availability of funding next year. It is expected that this will further increase Cappagh hospital's capacity for paediatric orthopaedic services.

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank the Minister of State for her reply. While I welcome the facts that she laid out, the additional funding will not be transformative enough to reduce the waiting lists dramatically. That is the sad reality.

As Deputy Cahill alluded, and speaking as a former patient myself, the ethos in Cappagh hospital is one of can do, will do. It wants to carry out more procedures and treat more patients but it needs additional theatre capacity and bed capacity. It has to replace some of its outdated existing accommodation and, of course, Covid imposes extra requirements. The hospital wants to meet all the necessary accommodation requirements.

I know some of the children who are on the waiting lists. I am conscious of their suffering and the distress and worry caused to their parents by the long waiting lists to access much-needed treatment. I spoke to the mother of a 14-year-old who was waiting for treatment. I discussed the case with that young boy's mother again last Sunday morning. She said that he had gone back to school. He is not mobile. His friends are participating in their sports but he is not because he cannot get the treatment and surgery he needs. Sadly, there are hundreds of other children in the same predicament. Cappagh hospital has top-class clinicians and support staff who want to treat them, carry out their procedures and give them the quality of life they need, the quality of life that we want to see every child in the country have.

As Deputy Cahill stated, a detailed and costed proposal is with the Department. It could be transformative if the additional capacity was provided. Cappagh hospital is not crying out for additional staff. Rather, it is crying out for additional accommodation in order that it can do more work to ease the pain and suffering of children and adults throughout this country. It is the national orthopaedic centre. It treats patients from every county in our State. We need to give it the resources and capacity that would allow it to reduce waiting lists dramatically. None of us wants to meet in our clinics or talk on the phone to people of all age groups who are suffering and immobile. It is not good enough.

While we know the hardship and suffering that the pandemic has brought to this country and to so many families, the Taoiseach has rightly suggested that it might transform how we deliver healthcare. Let us be transformative and put in place the investment and facilities to ensure that a better quality of life is provided to these people, in particular the children waiting for treatment.

Photo of Jackie CahillJackie Cahill (Tipperary, Fianna Fail)
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Deputy Brendan Smith has put it well. Detailed plans have been drawn up for a modern unit. Unfortunately, the current infrastructure will not meet HIQA's standards in future. Investment is essential. The hospital has a tremendous record. It breaks even every year and sees a significant throughput. Its figures are the envy of other hospitals within the health service. We can make a dramatic impact on the waiting list for orthopaedic surgery by investing in Cappagh hospital. It has the necessary space, which is something other hospital sites do not have. I saw its high-dependency unit on Tuesday morning. It is old-fashioned and not fit for purpose. The hospital's single-bed units are not fit for purpose either. An old building, the hospital used to be a convent.

It needs significant investment. We have a golden opportunity to reduce waiting lists. As Deputy Brendan Smith said, it is galling for all of us when people come to us and we cannot get them the operations they urgently need.

I appeal to the Minister of State and I know her heart is in this. We have an opportunity to work with Cappagh, which is the national centre for orthopaedic surgery. It has the plans there. We can use the window of opportunity provided by the Covid pandemic to get planning permission through in double quick time and we should not let that opportunity pass. A modular unit can be put up very quickly. It should stand as a monument to us all, showing we did something to reduce the significant waiting lists. It can be done but not at great cost to the Exchequer. A total of €70 million would deliver what we want to deliver in Cappagh, and it would be a great achievement for the Government, of which I am proud to be a member.

8:30 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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The two Deputies have made a compassionate and compelling case.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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It is a very good case. Yesterday I met the Minister, Deputy Donnelly, to discuss children and waiting lists. Every week, I sit beside Deputy Smith, because that is where my normal seat in the House is. Every week I discuss with him access to children's rheumatoid services. I am acutely aware of the conversations we have had. Every evening I see posts on Twitter about children who cannot access orthopaedic services. I talk specifically about Down's syndrome when I have this conversation.

I will take on board the compelling pleas both Deputies have made today. I hear exactly what they are saying. We want to leave a legacy showing we can do it differently in health, we can make priorities and we can provide access to care. Yesterday, I spoke to the Minister, Deputy Donnelly, about funds for access to care and how the money can be used to make a difference to young people's lives. How will we prioritise? How will we clear our waiting lists? How can we ensure the parents, many of whom come to our constituency clinics and who are waiting for far too long, can access it?

I would like to see Cappagh, as Deputy Cahill has done this week. Everybody speaks very highly of the services it delivers. It would be wonderful to see how it can put an action plan in place to deliver on the assessments and if the investment could be made there. I would like to attend it and perhaps Deputy Cahill could set that up for me.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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The car is on its way for the Minister of State already.

The Dáil adjourned at at 8.53 p.m. until 12 noon on Wednesday, 5 May 2021.