Pat Buckley (Cork East, Sinn Fein)
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I meet the Minister of State again at the handy times and he gets all the handy ones. While I am bringing this up, I want to put on the record that the Minister, Deputy Donnelly, also has the full documentation on what I am about to raise. Ms Katie Byrne is a young lady aged 17 from Cobh. She has been waiting for an operation since she was four years old. Katie's family have been through hell for the past 14 years and Katie has been damaged mentally. After a recent visit to the hospital on Monday, 22 January 2024, she was told by a specialist that if they operated on Katie, she would never walk again. This has really upset Katie and she has lost total trust in our health services. A recent article in The Echostated:

Katie said that the possibility of having to return to a wheelchair permanently has left her “terrified.”

“It’s like I’m screaming but nobody is listening,” she told The Echo.

The transition year student has once again become reliant on crutches and her wheelchair. She said she is extremely disappointed that the HSE has left her family with no option but to fundraise due to restrictions on what country she can be treated in through its treatment abroad scheme...

[Katie said] “I do my best not to cry in front of doctors because it just causes a scene. However, this happened recently and the doctor had to apologise for making me upset. It can feel so isolating.

"Every time a doctor tells me there’s a chance I might end up needing my wheelchair, I’m terrified ... I got out of my chair. I don’t want to have wasted the last 10 years of my life just to get back into it.”

The 17-year-old had a message for the HSE:

My message would be not to look at the X-ray and look at the person in front of you. If I'm telling you I'm in pain then I'm in pain. All I want is for people to believe me instead of disregarding what I'm saying...

I generally experience upset more than I do anger. The fact that I haven't even been offered a referral from those who can't help me or a small contribution for my operation is particularly frustrating. Instead we are being sent from doctor to doctor, all of whom are telling us the same thing.

On Monday, I met with the family here in Leinster House. Katie has now gone from being in the children section to being in the adult section. She was physically upset. She is an amazing strong lady who has been looking for this hip operation from four years of age. Her mother contacted the surgeon they had contacted previously, an American top surgeon, who can do this operation. Her mother wrote:

On talking to this doctor who was very dismissive of you doing both surgeries at the same time because you would weaken her femur and weaken the already weakened muscles, he outlined some risks and basically scared the living daylights out of Katie to the extent that she is now terrified to have surgery anywhere.

Some of the risks highlighted were:

1. Risks of blood clots

2. Risks of Katie never walking again should she have the surgery

3. Because she has cerebral palsy the muscles around the pelvis would be weakened to the extent that she would be left in a wheelchair permanently.

In his reply the surgeon stated:

I appreciate the local surgeon's concerns. However, I don't agree with him. The pelvic operation is done in a way not to disturb major hip muscles. I have done this many times on CP patients and have never made their outcome worse than before. Not only have I not weakened but the opposite, it made the function better because of the improved mechanics.

Regarding doing the femur and the pelvis at the same time: This is something we do all the time. The femur part of the procedure is done using an intramedullary nail (rod inside the bone). We are able to do this part minimally invasively. Meaning only a few tiny incisions.

I will come back to it later.

Catherine Connolly (Galway West, Independent)
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I know the Deputy has permission from the family but he is also quoting somebody who is not here.

Pat Buckley (Cork East, Sinn Fein)
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I can finish on this one.

Catherine Connolly (Galway West, Independent)
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He is finished now, but he can come back in. I am just asking him to be careful.

Pat Buckley (Cork East, Sinn Fein)
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No panic.

Neale Richmond (Dublin Rathdown, Fine Gael)
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I thank Deputy Buckley very much for sharing that story in the Chamber. In our constituencies we come across families who face these challenges and it is absolutely heartbreaking for the entire family, entire community but, first and foremost, for the patient at the centre of it. I know the Deputy will continue to make the case for that individual, as he has been doing as a local representative.

Regarding waiting times for orthopaedic surgery patients in Cork East, this feeds into the overall national change that sees that for the second year in a row, national hospital waiting times and waiting lists actually fell. On the core Sláintecare wait time target, an 11% reduction was achieved along with a 3% reduction in overall waiting lists. The target of removing approximately 1.66 million patients from waiting lists in 2023 was exceeded by 5%, with around 1.74 million patients removed. However, higher than anticipated additions to the waiting lists impacted on the total waiting list figures, offsetting much of the progress achieved.

With regard to the number of patients waiting in Cork hospitals for an orthopaedic inpatient or day-case procedure, the most recent figures published by the NTPF for the end of December 2023 indicate there are 311 patients waiting for such a procedure at Cork University Hospital and South Infirmary-Victoria University Hospital. This current figure represents a slight decrease of 2% in the number of patients waiting since the end of December 2022.

Some 54%, or 168 patients, are currently waiting outside the 12-week Sláintecare target for an inpatient or day-case procedure. This Government’s commitment to both of these hospitals can be seen in the increased resources assigned to meet the needs of patients. The budget for CUH has increased by 42% since 2019, and the budget for the South Infirmary has increased by 24% in the same period. In addition, there were significant increases in staffing in the same period, with the staffing complement in CUH and SIVUH increasing by 30% and 35%, respectively.

The National Treatment Purchase Fund continues to work with hospitals throughout the country to offer and provide the funding for treatment to clinically suitable long-waiting patients who are on an inpatient, day-case or outpatient waiting list. The key criterion of the National Treatment Purchase Fund is the prioritisation of the longest waiting patients first, identifying patients eligible for NTPF treatment solely on the basis of their time spent on a waiting list. It should be noted that the decision to outsource a patient, the suitability of patients to be outsourced for such treatments and the prioritisation of patients for treatment remains the decision of the referring hospital and its clinical decision-makers.

To build on the progress achieved to date, funding totalling €407 million is being allocated this year to tackle waiting lists, with €332 million of this allocated to the 2024 waiting list action plan and the remaining €75 million targeted at various measures to alleviate community and primary care waiting lists. The funding will encompass core HSE activity, additionality provided through both the NTPF and the HSE, as well as progressing new service developments to further reform elective care.

That is of cold comfort to the family and the patient on whose behalf the Deputy is speaking. However, those are the statistics provided to me here this evening by the Ministry for Health. Individual cases are always difficult. There are always anomalies and many different issues need to be gone through. The Deputy is making representations on behalf of a patient, her family and the people of Cork East more generally. I will happily do anything I can to work with the Deputy and with the Minister to help them.

Pat Buckley (Cork East, Sinn Fein)
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I appreciate the Minister of State's response. We have worked on issues before, which he has resolved and for which I thank him. I know we have capacity but we also have capacity and performance issues. Based on this response, I can assure the House that this will not set her back from walking. She will be up and out of bed using a walker within a day or two of surgery. Her muscles will work better due to the improved hip mechanics and so they will seem stronger, not weaker.

The National Treatment Purchase Fund is not on the cards because she has to go to America. It is €300,000 for the operation. They have already set up a GoFundMe but I raise it here because I cannot understand why this poor girl has been listening to various doctors and specialists for 14 years and it seems nobody has the capability in this country to carry out that procedure, yet there is a full institution in the US that has a number of experts who do this daily.

Of course I did not expect an answer because the Minister of State does not have the details of the case, and that is fair enough, but my appeal is based on the fact that Katie is probably not the only person in this country in these circumstances. It may not be just hip operations. I understand the point about the National Treatment Purchase Fund, but is something more not possible? Families work here, pay tax and pay into the health system. Has the Government thought of putting €1 million or €5 million aside every year out of a budget to cover specific cases like this? We have a duty when there are specialist cases. They are Irish citizens. Could we not have a fund whereby we pay for the surgery? I grant that they may have to do a GoFundMe for accommodation and flights, but let them have an option. This poor girl for the past 14 years has had nothing but problems and downfalls and to this day could never get an answer except GoFundMe. That is why I wanted to raise it tonight. I have put it in to the Minister and I would love to discuss that option for people. I thank the Minister of State.

Neale Richmond (Dublin Rathdown, Fine Gael)
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The Deputy raises an interesting point. I think all of us have had a case or cases across our desk, or even had family exposure to such cases, involving cancer or orthopaedic care of treatment. It is always so much tougher when it is a treatment for a young person or child. Every day people leave the State to go for treatment. Many of them leave the State with the support of the Government to receive treatment. The much-maligned Government jet and the Air Corps spend much time bringing people for emergency treatment in the UK in sister hospitals in cases where treatment simply is not available on this island due to size, capacity, skills, etc. There is not a specific fund but a considerable amount of money is spent every year to support patients to get treatment outside the State. There is, through various provisions in the European Union and the UK, the option for people to seek treatment abroad.

The case the Deputy raised, like any case, has its individual merits and complications. The easiest way is for the Deputy to sit down with the Minister or officials in the HSE to see if he can get a resolution for this poor child after 14 years. I am more than happy to bring that to the Minister on the Deputy's behalf.