John Crown (Independent) | Oireachtas source

Cuirim fáilte roimh an Aire Stáit.I wish to use these few minutes to bring to the Minister of State's attention a very frustrating problem which has arisen in the health service. It relates to a very promising, relatively new but well established technique called transcatheter aortic valve implantation, or TAVI. To put the Minister in the picture, aortic stenosis is a condition in which the aortic valve, which is one of the four major valves of the heart and the last place through which blood goes as it leaves the heart and goes out to the rest of the body, becomes narrowed. In sad bygone days we used to see this very frequently in times of social deprivation as a consequence of things like rheumatic fever. It is now mainly a disease that occurs in older people as a result of degeneration of the valve with age. This degeneration occurs in approximately 2% of older people and has a 50% mortality rate over two years. If it is severe and causing the patient to have symptoms, the mortality in one year is 50%. The symptoms tend to be shortness of breath, blackouts, chest pains, etc. Basically, the blood cannot get out of the heart and into the rest of the body.

I am old enough to remember that when I was an intern in the national cardiac centre at the Mater hospital, we had to go around getting consent forms from patients who were to have the very significant and intrusive operation of aortic valve replacement. Their chests would be opened, they would be put on the bypass machine and their hearts would be opened. There was an appreciable chance of dying on the operating table, despite the great skills of surgeons such as the late, great Maurice Neligan and others who brought this procedure to Ireland. Through one of the great miracles of innovation, there is now a way of doing this in a minimally invasive fashion by threading a catheter through the blood vessels to the heart and, by way of wonderful skill and technology, implanting a valve without having to open the patient's body or heart. This is obviously a vastly better way to proceed because, in the past, many patients who needed this procedure could not have it done as they were too sick for the operation. It was a vicious circle. They had a serious diagnosis and needed the operation but they could not have it. They needed a general anaesthetic and intensive care. In our system, of course, there is a desperate shortage of intensive care beds. One can understand, as such, how difficult this problem became.

The new technology is wonderful. People are in hospital for as little as two nights and they do not have to go into intensive care. Some of them avoid a general anaesthetic altogether and the operation is done under a deep level of sedation without the input of an anaesthesiologist or anaesthetist to put them to sleep. This is a win-win situation. The actual piece of hardware that is put in - the valve - is more expensive than the valve that is put in through the traditional big, onerous and dangerous operation. It costs approximately €16,000 to €17,000, as opposed to €5,000 to €7,000. The Minister of State has been in the health service for a few years now and will understand the potential for colossal cost savings if people do not need to go into intensive care, do not need all the tests carried out and are not subject to the complications of major surgery. Instead of being in hospital blocking up beds that could be used for other people, people would have access to a simpler and safer procedure with good outcomes and with less time in hospital. The problem at the moment is that it is done in an uncoordinated fashion. We have three centres, at the Mater, St. James's Hospital and University College Hospital Galway, staffed by extraordinarily skilled and dedicated people who are doing the best job they can. It is not a national service, however.

The case that precipitated this particular discussion arose in St. Vincent's Hospital, where this procedure was recommended to a patient by skilled cardiologists. They correctly arranged for the patient to go to the Mater hospital, which is our designated centre, but the Mater has imposed a limit because it is not a national centre. That limit is 17 procedures per annum. The 17th procedure will take place in August, which means the Mater cannot do any procedures after that. The Mater is asking hospitals that are referring patients for a procedure which by definition can only be done in a small number of hospitals to bring their own funding. This is a colossal problem and, unsurprisingly, the number of TAVI procedures carried out here is only one third of the number carried out in the United Kingdom.

In truth, the UK is pretty poor on most metrics. It has a mediocre health service by the standards of the better social democracy medical systems in Europe, such as those of Germany, the Nordic countries and France. If one looks at the European league table, Ireland is at the very bottom. We are the lowest in terms of TAVI procedures.

We have a real problem here. It is a classic example of a problem which is purely administrative. If there were a recognition that this was a national need and not a matter of a number of isolated islands of excellence that, understandably, are giving priority to patients within their own catchments, we would not have developed a sort of geographical or postcode apartheid for the procedure. I happen to know that my good friends and colleagues in the Mater, who have been doing a phenomenal job - for which I thank them on behalf of patients from their hospital, St. Vincent's and all other hospitals that are sending them patients - have been beating the bushes to try to get this problem rectified. One of them told me that clinicians are attempting to bring this to wider attention, but their concerns are falling on deaf ears. This could be a win-win situation. The procedure is good for patients, waiting lists and economics and it is something we should do very quickly. The problem is that we are too used to the abnormalities of our health system, whereby people can be on waiting lists for six months or two years. One cannot be on a waiting list for two years for this procedure, as one will disappear from the waiting list on average after one year. These people are no longer a vocal group pushing for reform, because they have died. It is a matter to which the Minister of State should give urgent attention.