Seán Sherlock (Cork East, Labour)
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The Minister has previously addressed this but I wanted to raise again the issue of access to ophthalmology services in the CHO 4 region, which covers County Kerry, north Cork, north Lee, south Lee and west Cork, which is presenting challenges. More than €200,000 has been spent on private providers in this area in the past while and more than 3,000 children are still waiting for ophthalmology intervention in the area. It appears that recruitment continues to be a significant issue. On 2 December 2022 I received correspondence from the South/SouthWest Hospital Group on foot of representations I made by way of a parliamentary question, where I asked the Minister for Health, Deputy Stephen Donnelly, the number of staff, the grade and the length of service of each member currently assigned to ophthalmology services across Cork hospitals and the number of vacancies in the same hospitals. I was told that there were approximately 39 whole-time equivalents in Cork University Hospital, CUH, but that the number of vacancies for whole-time equivalents is two. For South Infirmary Victoria University Hospital, SIVUH, it is 25 with a vacancy rate there of 2.7 whole-time equivalents while in the Mercy University Hospital, MUH, the number that came back is zero. The Minister told me that the South/SouthWest Hospital Group has advised that it "expects the new operating theatres will be opened in March 2023".

Will the €5 million ophthalmology unit will become operational in March, as has been articulated in the past? What comfort can the Minister of State give to those people who are seeking to access public services now that the required number of vacancies will be filled? I fully appreciate that the HSE will spend considerable amounts of taxpayers' money on waiting list initiatives but the cost to the Exchequer of waiting list initiatives is increasing dramatically. In November 2021, 39 patients were referred to one of these lists at a cost of €15,000 while in June last year, 559 patients were referred to a private company at a cost of €83,000. If we want to get people through the list, that is fine and I do not think anybody has any issue with that but is not good value for money when we have a unit costing €5 million that is supposed to be for public service sitting there and there are still recruitment issues into the public service. We do not want to see a continuation of a waiting list initiative by private providers when it can be done through the public realm. It all boils down to the 3,022 children waiting for ophthalmology interventions I represent. That is a significant number. I seek comfort from the Minister of State that what the taxpayer has invested in will become operational.

Anne Rabbitte (Galway East, Fianna Fail)
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I am taking this matter on behalf of the Minister for Health, Deputy Donnelly so I will stick to the script so the Deputy will have his accurate answer. On behalf of the Minister, I thank the Deputy for raising this issue. The Government accepts that access to appropriate care is an important part of maintaining optical health. The HSE provides these services in hospitals and in the community. This includes specialist clinics for complex issues and routine testing by optometrists. Cork Kerry Community Healthcare currently operates paediatric community ophthalmology services across counties Cork and Kerry. The staffing profile of this service includes community ophthalmology physicians, optometrists, orthoptists and nursing staff - I apologise I am getting caught with the words this morning. Recruiting staff to these highly specialised areas can be challenging. However, the need for these specialist staff is recognised by the national clinical programme for ophthalmology.

As the Deputy said, ophthalmology services are also provided at three Cork hospitals, namely, Cork University Hospital, the South Infirmary Victoria University Hospital and the Mercy University Hospital. These services combined employed just over 65 whole-time equivalent staff at the end of 2022. At that time, more than four whole-time equivalents required recruitment. A regional eye care service is currently under development to serve the area. This involves collaboration between Cork Kerry Community Healthcare, the South/Southwest Hospital Group and the SIVUH The service will be based at the new primary community care centre in Ballincollig and will provide a designated specialist infrastructure for community procedures related to ophthalmology. These will be performed by the multidisciplinary team, which includes multiple grades of staff. This will allow maximum use of skills to deliver the best outcomes for children and adults. The project is in line with the national clinical programme for ophthalmology, which recommends the integration of hospital and community care, and that clinicians and care providers work in teams. Efficient operation of such multidisciplinary teams will be essential to delivering primary eye care. Standards of clinical care will be maintained by clear governance structures and clinical audits.

A community-based model will improve access to care and will also alleviate some of the pressures on hospital services. The positive effects of a community-based approach can be seen in CHO 6, CHO 7 and CHO 9, where primary care eye teams have been introduced. The teams have made a substantial impact on waiting lists in these CHOs. Their community-based treatments allow hospitals to focus their resources on more complex cases. The building in Ballincollig is operational and ready for equipping to deliver the integrated eye care service. This awaits funding approval from the HSE. However, stakeholders will meet tomorrow, 16 February 2023, to discuss what elements can be operationalised from within existing resources.

I feel I have not answered the question. I feel I had a better answer on a previous occasion I responded to a similar Topical Issue matter. I will listen to the Deputy's response.

Seán Sherlock (Cork East, Labour)
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The Minister of State is sending a message back to the machine and the system. I appreciate that. I also appreciate the fact that she is taking this issue on behalf of the Minister and answers are not always readily provided to her.

I take some comfort from the fact that the building in Ballincollig is operational and ready for equipping to deliver the integrated eye care service. That gives me grounds for some hope. However, there seems to be a juxtaposition in the reply because the Minister of State's next sentence mentioned that the integrated eye care service "awaits funding approval from the HSE". She also said the stakeholders are meeting tomorrow. I am not directing this at her per sebut in her reply, she said the building in Ballincollig is operational and ready for equipping. I need to know if it is going to be fully funded. The ophthalmology unit based in SIVUH, which cost €5 million, is not operational. I need some comfort for the people I represent in the CHO 4 area in order that I can assure them there will be seamless access to services, whether on a community basis or at consultant level.

The Minister of State made reference to the involvement of community. There is greater scope for community opticians to become involved in all of this but what they are telling me is that the €23 they get per medical card patient is not worth their while, given the associated administrative burden. Some people are leaving the system. If we are talking about a front-door system, where the front door is a GP or community optician, we must make it financially viable for community opticians to be able to deliver more. They cannot do that at €23 per patient because it does not reflect the cost of providing the service.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy. The Minister and I appreciate that access to appropriate and timely optical services is a concern for many residents of Cork and Kerry. This is the second time I have answered on this. I assure the Deputy that ophthalmology is a priority issue for the Minister and his Department in 2023. He wants to see reform in this area to ensure people receive the service they require. I mentioned the HSE in my response and said that funding is an issue. Perhaps the fact that the service plan has not been signed off on or has not yet been completed and handed over to the HSE means that is the parcel it is awaiting. Reform in the area includes making the best use of the skills of many talented optical clinicians who live and work in Ireland. The Minister accepts that recruitment continues to be an issue and is liaising with the Minister for Further and Higher Education, Research, Innovation and Science with the intention of seeking an increase in the number of professionals trained in optical services. This will be needed, along with targeted recruitment, to increase capacity in the healthcare system and, looking forward, he is eager to see the expansion of community-based care. This will require increased integration between hospital and primary care providers. Success will depend on innovative, effective models of care that make the most of our resources. The collaborative work on the Cork-Kerry regional eye care service has been impressive. This progress offers reassurance that other such patient-centred services can be established in the future. Departmental officials will continue to liaise with Cork Kerry Community Healthcare to monitor the progress of the proposed eye care service.

My take away from what the Deputy said relates to the financial viability of community opticians and the role they can play. Perhaps it is something we should look for in CHO areas without such specialist teams.