Kieran O'Donnell (Fine Gael)
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I wish to raise surgery treatment for cataracts, which more particularly affects the elderly. Huge difficulties are encountered by people in need of such treatment in Limerick and the mid-west. As we speak, 783 people in the mid-west are waiting approximately 15 months for cataract surgery from the time they had their assessment. That is not acceptable. Many elderly people have come to me to raise the issue. Following surgery people go overnight from a situation of being almost blind to being able to see. One elderly gentleman who came to see me recently told me he was on the waiting list to have surgery on both eyes. He was so distraught that his family came together to ensure he could have an operation on one eye at a cost of €2,000. The operation was carried out in Ireland which meant it did not qualify for the treatment abroad scheme and he was not on the waiting list for sufficiently long to qualify for the National Treatment Purchase Fund.

We must find ways to allow such people to have the operations they need. A proposal is before the HSE at the moment from the University of Limerick hospital group to develop a cataract surgery hub at Nenagh General Hospital.It would seek to operate five days per week. A full complement of staff would be in the order of 16, including two ophthalmologist consultants, two registrars, two clinical nurses, two general nurses, one advanced nurse, two ophthalmologists and clerical staff. The revenue budget would be approximately €1.75 million per annum in order to have the facility fully up and running. There is a capital cost of €500,000 to buy equipment. If the facility is fully up and running, is will deal with approximately 45 cases per week. The waiting list would be gone in nearly a year.

I am asking that the Department and HSE would give the go-ahead for €500,000 to meet the capital cost. It would take three or four months to commission the equipment. The start date would be in quarter 2 of 2018. It would be possible to get the equipment under existing tender frameworks. The minimum complement of staff required to get the facility up and running is approximately six, involving one consultant ophthalmologist, one registrar, three nurses, and one member of ancillary staff. Approximately €500,000 per year would be required. The Minister could allocate €375,000 for revenue for 2018 and €500,000 up-front to meet the capital cost. This amounts to €875,000. What I propose has to be done.

The reason I refer to Nenagh General Hospital is because it has a state-of-the-art theatre, two brand-new theatres, a day ward and a procedure room in place. It is a model 2 hospital. It is very much in keeping with the thinking on elective care. As matters stand, cataract surgery is being done at the university hospital on the regional site. The number of procedures is in the order of 30 to 35 per week. At times, however, the theatre must be reserved for acute emergency procedures. That work will continue. In addition to the 30 or 35 procedures per week at the regional site, we want an additional ten to 15 procedures to be carried out per week, resulting in up to 45 per week. This would require an allocation €875,000, including €500,000 to meet capital expenses and €375,000 for revenue. Over time, the figure should be increased to €1.75 million in order to carry out 45 procedures per week. This is an urgent matter for Limerick and the mid-west.

Finian McGrath (Dublin Bay North, Independent)
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I thank the Senator for raising these important issues. He is a strong advocate for disability and health services in the Limerick and mid-west areas. I was in Limerick recently at an awards ceremony dealing with young people with disabilities and addressing the matter of training people to work at preschool level. I thank the Senator for his work in this regard. I intend to return to Limerick to visit the services properly as soon as possible.

I welcome the opportunity to address the House on this matter and outline the measures that have been taken to reduce waiting lists for cataract surgical procedures. The position is that, given the long wait for outpatient, inpatient and day-case ophthalmology procedures, the HSE is currently undertaking a demand capacity analysis for this speciality. The HSE has established a steering group and, to date, work has been undertaken on identifying current capacity, projecting future demand for cataract procedures, and how to enhance public hospitals' capacity to meet patient demand.

As part of this demand capacity analysis, work is ongoing to identify possible capacity measures to address cataract waiting lists. Possible future measures include the development of new units and maximising the use of theatre sessions that are currently unused. There is potential to provide more eye care services within primary care, which would help to divert patients from acute hospital services. Expansion of services at hospitals is, of course, another option. In that context, the hospital at Nenagh has been identified as a possible location where ophthalmology services could be developed. Such a service has the potential to help reduce the waiting time for patients in the mid-west and also to provide services for some patients from outside the University of Limerick hospitals group.I understand that the cost of service development, both capital and revenue, has been scoped out by the University of Limerick Hospitals group and has been submitted to the HSE acute hospital division to help inform the demand-capacity analysis. I understand that work on the demand-capacity analysis is not yet complete. I look forward to receiving a report from the HSE in due course.

The House will be aware there has been significant progress throughout 2017 to reduce waiting lists, including for cataract procedures. The HSE and National Treatment Purchase Fund, NTPF, have worked together to continue to drive down long wait times for inpatient and day case procedures. Waiting list numbers published by the NTPF at the end of October show that the number of public patients on the active waiting list for cataract surgery has been reduced by over 16% over the past six months. Between April and the latest available figures, the number on the overall list fell from 13,552 to 11,863. The cataract waiting list fell from 10,304 to 8,667. The waiting list of patients waiting more than 15 months for cataract procedures was reduced from 1,694 to 421. This reduction shows the combined Impact of both the HSE's waiting list action plan and the NTPF’s waiting list initiatives to reduce waiting list numbers.

The NTPF continues to authorise treatment for cataract surgery and to work with both public and private hospitals to access treatment for patients. These reductions in waiting lists are promising. I am aware and accept the Senator's point that more needs to be done to tackle waiting lists in the future. To that end, budget 2018 provided an additional €10 million in 2017 for further waiting list initiatives including cataract procedures for the remainder of 2017. Next year, €55 million is being allocated to the NTPF, which more than doubles the 2017 allocation of €20 million. This significant increase in funding reflects the fact that reducing waiting times for patients is one of the Government's key priorities. This funding will enable the provision of treatment for patients across a range of procedures, including cataract procedures.

Ned O'Sullivan (Fianna Fail)
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The Senator has just one minute because we are trying to avoid a Dáil vote.

Kieran O'Donnell (Fine Gael)
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I thank the Minister of State for his reply. I have a few observations. He spoke about the National Treatment Purchase Fund. In the mid-west, 500 cataracts operations took place, covered by the National Treatment Purchase Fund at a cost of €2,000 per operation, which amounts to €1 million. The aforementioned hub for cataract operations in Nenagh would provide value and enable people to have cataracts treated in their home area. I ask the Minister of State to follow up with the HSE acute hospitals division to get a sign-off on the €500,000 to enable the capital procurement to start to take place. We are looking for €375,000 for 2018 to enable the procedure and to get this measure off the ground. I feel passionately about this. It has to happen. We have 783 people, mostly elderly, waiting for cataracts operations in the mid-west for up to 15 months. That is inhuman and cannot be allowed to happen. I ask that the sign-off now take place for the capital to enable equipment to be purchased to enable operating to begin from the second quarter of 2018 and to ensure we can reduce the waiting list over time in order that instead of people with cataracts being obliged to operate in darkness for 15 months or more, they can at least enjoy their existence and be able to see things.

Finian McGrath (Dublin Bay North, Independent)
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I will bring the Senator's concerns about Nenagh and the €375,000 back to the Minister and the HSE, and I will bring that message to the acute hospitals division too. I agree that the figure of 783 people waiting in the mid-west is not acceptable and that we have to act promptly. If an extra €55 million is spent next year to deal with waiting lists-----

Kieran O'Donnell (Fine Gael)
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Capital is also needed for the equipment.

Finian McGrath (Dublin Bay North, Independent)
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We will have to be creative and see if there is funding within that budget.