Michael Comiskey (Fine Gael)
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I welcome the Minister for Health.

Colm Burke (Fine Gael)
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I also welcome the Minister and thank him for dealing with this matter.

I have a concern about a vacancy that has arisen at Beaumont Hospital where Professor David Hickey was a consultant for many years and provided an excellent service in carrying out transplants. I understand he has retired and that a second consultant who worked at the hospital has returned to the country. The number of transplant consultants has been reduced to four in total when it should be eight, which means that we have a major problem.

In the past six months the figures for transplant procedures were presented on a number of occasions to us at the Joint Committee of Health and Children where comparisons were made with the position in Norway, which has a population of 4.8 million, of whom only 370 are on dialysis. In Ireland there are over 1,800. A transplant saves the Exchequer in the order of €750,000 in real terms, which is a huge saving for the country.

The appointment of consultants is an issue about which I have been concerned for some time. Last October, at the Joint Committee on Health and Children, I asked representatives of the HSE a question, only to be told in reply that there was no information available at a national level on the number of posts which were vacant. At the time I advised the HSE that if it was to give me the name of one porter in each hospital around the country, I was sure I would be able to obtain the information. It was a further six months before I eventually received a list which indicated that there were over 300 vacancies.

This issue dates back to the time of Comhairle na Ospidéal which was subsumed into the HSE in 2004. When Comhairle na Ospidéal was in place, a vacancy would have been flagged by a health board at least 12 months in advance, advertising would have taken place and the post would have been filled as soon as the vacancy arose. We now seem to have a policy of advertising vacancies only after they arise. There is a lack of long-term planning, which seems to be the case at Beaumont Hospital. Responsibility for filling the vacancy seems to lie with the HSE, Beaumont Hospital and the Department. What we need is clarity. We must decide how to fast-track the filling of the post and how to make it attractive enough for someone to apply from abroad if there is no one available in Ireland to fill it. A candidate may be Irish, but at least such a process would ensure the post was filled and thus allow us to meet the target for the number of transplants to be undertaken in this country.

Leo Varadkar (Dublin West, Fine Gael)
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The consultant who carried out pancreas transplants at Beaumont Hospital took early retirement at the end of 2014. Given the limited number of surgeons who specialise in transplantation, the filling of such vacancies poses a challenge. While Beaumont Hospital is making every effort to recruit a suitable replacement, it is also collaborating with St. Vincent's University Hospital on a combined approach to kidney and pancreas transplants. It is proposed that pancreas transplants, of which six were performed in 2014, will be carried out in St. Vincent's University Hospital.The two hospitals, together with Organ Donation and Transplant Ireland, ODTI, which is part of the HSE, and my Department, are working to make arrangements to facilitate the commencement of this work as soon as possible.

Most pancreas transplants are combined with a kidney transplant. These cases will involve transplant surgeons from St. Vincent’s University Hospital and Beaumont Hospital working together in St. Vincent’s University Hospital. In addition to working with St. Vincent’s University Hospital in a combined approach to kidney and pancreas transplants, Beaumont Hospital is collaborating with it in the development of an intra-abdominal organ retrieval service that will facilitate a more effective and cohesive overall procurement and transplant service.

In May Beaumont Hospital wrote to all patients who had received a pancreas transplant, in addition to all patients on the transplant waiting list. It has also written to all referring consultants. At this point, all pancreas transplant recipients have been seen by clinicians in Beaumont Hospital or have appointments in place. Future pathways of care are being discussed with all patients at these meetings.

A joint assessment clinic for the eight patients waiting for a pancreas transplant, involving consultants and nurses from Beaumont Hospital and St. Vincent's University Hospital, will be held on 24 July. Management and clinical staff at the hospitals are committed to ensuring an optimal service will be put in place for the long-term benefit of those in need of pancreas transplants. As St Vincent’s University Hospital is already established as the national liver transplant centre and is a designated centre for pancreas cancer services, it is well placed to undertake pancreas transplants. Every effort is being made to have all of the necessary arrangements and protocols in place to facilitate St. Vincent's University Hospital to be in a position to undertake pancreas transplants from mid-September should there be a suitable donor-recipient match.

Additional funding of almost €3 million has been provided to facilitate the development of the most appropriate infrastructure to support organ donation and transplantation. This will facilitate the appointment of 19 whole-time-equivalent staff dedicated to organ donation and transplantation across the country. Included in this number are five organ procurement co-ordinators who have been appointed and six organ donation nurse managerswho will be in postin each of the hospital groups by the end of August.

I recognise all of the families who have facilitated the donation of the organs of their loved ones, often to the benefit of several recipients. I reiterate my commitment to enhance organ donation and transplantation rates for the benefit of patients and their families.

Colm Burke (Fine Gael)
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Dr. Hickey took early retirement, but surely this was flagged in the hospital beforehand. Why was there such a delay in advertising for a replacement? What is the HSE now doing? Considering that it took me six months to obtain a list of vacancies from the HSE, it appears that there is no national co-ordination. I asked what consultants were to retire in the following 12 months and in what number, but the HSE could not give me an answer. This is an extremely important issue which concerns long-term planning. It is clear from what has occurred that there was no long-term planning. There is none; the matter is being put on the back burner. It is no longer acceptable that there are long waiting lists. We can talk all we like about waiting lists, but until such time as we sort out the issue of consultant appointments before they arise, we will be complaining about waiting lists for the next 20 years. This matter needs to be prioritised. With regard to appointments, we are down to four consultants carrying out transplants. What incentive is going to be offered to try to bring people back from abroad to take up the vacant posts?

Leo Varadkar (Dublin West, Fine Gael)
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The post was advertised. I cannot say with absolute certainty when it was advertised, but it was certainly advertised many months ago. However, it was not possible to find a suitable applicant. As the Senator will know, the health service works in such a way that the HSE is not always the employer. Beaumont Hospital, for example, is a voluntary hospital. Therefore, the people who work there, in St Vincent's University Hospital and many other hospitals are not actually HSE employees but employees of the voluntary hospital. As a consequence, recruitment procedures vary. There is direct recruitment by the HSE and also recruitment by individual voluntary hospitals. Quite a large number of consultant posts have been advertised in recent months. Advertisement is through the Public Appointments Service which fills the posts. It is trying to speed up the filling of posts, but sometimes it can take time because recruits have to give notice elsewhere before taking up a post, particularly if coming from overseas. There are difficulties in attracting applicants or any applicant in some cases, particularly when the job is not in one of the major cities. That is a particular difficulty. Obviously, any incentive that can be offered is limited because we are bound by the rules on public sector pay. The current structure does not give us flexibility to offer bespoke contracts, top-ups or incentives.