15/07/15 Senator Daly Speaks on Transplant Patient Services

Senator Daly: I move:

“That Seanad Éireann calls on the Government to ensure:

– that the vacant posts in Beaumont Hospital in urology, with an interest in transplantation, be categorised as very urgent and receive an exemption to the current pay scales on offer;

– that the recent practice of instructing transplant patients to attend hospital Emergency Departments be complemented by providing access to Senior Specialist Nurses or attending Renal Registrars first; and

– the commencement of the Treatment Abroad fund to provide dual kidney and pancreas and pancreas only transplants for people on the waiting list so that the available donated Irish organs can be utilised.”

The issue with respect to Beaumont Hospital and the situation regarding the retirement of Professor David Hickey is causing great anxiety among the 526 people who are awaiting kidney transplants and the eight people who are awaiting pancreatic transplants. As we can imagine, the uncertainty surrounding organ donations services in such a life and death situation is a concern for a patient who is waiting for a telephone call regarding their situation.

We included the first point in the motion following consultation with those who are experts in the organ donation area. The current pay scale being offered to recruit a new surgeon is €110,000. That can be compared to a pay scale of €700,000 on offer in the United States for the same level of expertise. It is little wonder that the four attempts to fill the post have not succeeded. The description for the post needs to be changed to some extent and the pay scale on offer must be breached. Otherwise, it does to matter how many times the HSE advertises the post, when we are competing with Canada, the United States, England and Australia for the same very small pool of experts we will not win that battle. The Minister must overcome the issue of breaching the pay scale for this post.

I note from a reply the Minister gave Senator Colm Burke in response to a Commencement matter he raised on this issue – I look forward to hearing the Minister’s reply to this motion – that the Minister did not address the issue that these patients are being instructed to attend accident and emergency departments. As the Minister will be well aware, the last thing a transplant patient, who is ill, should do, or should be told to do, is to go to an accident and emergency department but that is what these patients have been told to do. A clear message needs to be sent form the Department that such advise is being reversed and that access to specialist nurses will be made available for these patients, as it was available in the past. The advice that has been given beggars belief and obviously that came from someone who does not understand the risks of sending a transplant patient into an accident and emergency department where he or she will pick up an additional infection, if he or she does not have one already. It can life threatening for a person to go there. Those patients need to access to specialist nurses and to the treatment abroad fund. I look forward to the Minister’s reply on that point. I note the Minister stated in that reply that every effort is being made. Four attempts have been made to fill this post without success. A fifth attempt will hardly be successful if the same pay scale and conditions are offered. Unless additional funding is put in place, we will get the same result.

The most important point is that the hundreds of people who are awaiting organ transplants are suffering anxiety and are in a state of distress as a result of this uncertainty.

—-Later—-

Minister Varadkar: I welcome this opportunity to update the House on the current situation in relation to pancreas transplants. Two consultant transplant surgeons left the renal and pancreas transplant programme at Beaumont Hospital at the end of last year, one on early retirement and the other on leave of absence for professional development purposes. Four consultant transplant surgeons remain and the renal transplant programme in Beaumont Hospital is continuing. Every effort will be made to fill the posts. Given the limited number of surgeons who specialise in transplantation, the filling of such vacancies poses a real challenge. Mr. David Hickey, who retired at the end of last year, performed pancreas transplants in Beaumont Hospital as well as his kidney transplant work. I acknowledge the work he did and the outstanding care he provided to his patients over the years.

Beaumont Hospital is now collaborating with St. Vincent’s Hospital on a combined approach to kidney and pancreas transplants. It is proposed that pancreas transplants, of which six were performed in 2014, will move to St. Vincent’s Hospital. Most pancreas transplants are combined with a kidney transplant. The arrangements being put in place for such cases will involve transplant surgeons from St. Vincent’s Hospital and Beaumont Hospital working together on the St. Vincent’s campus. I am informed that the pancreas transplants will be carried out by an existing surgeon who is already a member of staff at St. Vincent’s Hospital. As Senator Crown mentioned, other interviews are now planned by the hospital to fill other posts.A joint assessment clinic for patients who are waiting for a kidney and pancreas transplant, involving consultants and nurses from both Beaumont and St. Vincent’s, will be held on 24 July. Arrangements will be made shortly for the assessment of the three patients who are awaiting a pancreas transplant only.

Management and clinical staff at both hospitals are committed to ensuring that an optimal service will be put in place for the long-term benefit of those in need of pancreas transplants. As St. Vincent’s is already established as the national liver transplant centre, and is a designated centre for pancreatic cancer services, it is well placed to undertake these transplants.

On exempting transplant surgeons from current pay scales, as has been suggested by Senators, revised scales were agreed for new entrant consultants in January and were endorsed by the IMO in a ballot. Under the agreed pay structures, it is possible for consultants with experience to commence at the sixth point of the incremental scale, that is €155,000, rising to €175,000. It is also possible to appoint a consultant to a type C contract, which could mean somewhat lower remuneration but the ability to make substantial private practice income as well. Furthermore, it is open to health service employers to seek approval from the Department of Public Expenditure and Reform for entry of new consultants at a higher point on the scale in exceptional circumstances. If it is considered appropriate, this mechanism will be available in the case of a very experienced applicant for a transplant consultant appointment in Beaumont Hospital or St. Vincent’s, should one apply.

If a patient who is under the care of Beaumont Hospital after receiving a transplant encounters problems, they are asked to contact the renal registrar via Beaumont Hospital’s switchboard. If this occurs during daytime, they may be asked to present to the renal day ward for assessment. If the renal registrar is contacted by a patient out of hours, she or he will be advised to present to the emergency department first, where the patient will be assessed by the emergency department staff and also reviewed by the renal registrar, and-or the consultant nephrologist, if required. In addition, the patient can contact the transplant co-ordinators at Beaumont Hospital for guidance.

The treatment abroad scheme allows for public patients to be referred to another EU or EEA country or Switzerland for specific treatments not available in Ireland. It can also allow for the referral of patients where an undue delay is being experienced in access to a necessary treatment in Ireland. Given the logistical and time constraints involved, it is not practical to utilise the treatment abroad scheme to provide pancreas transplants in another country to patients who are living in Ireland, using an organ procured somewhere in Ireland. Furthermore, it would be necessary to develop protocols and service level agreements with the other country, something that would be unlikely to be achieved within the timescale of the proposed transfer of pancreas transplantation to St Vincent’s, which is a matter of weeks away, all going to plan.

I share the commitment of Members of Seanad Éireann to organ transplantation. I know it has been raised on many occasions in this Chamber. I want to see a further improvement in organ donation and transplantation rates in the coming years. I realise that the potential for transplantation depends on suitable donors becoming available, but there are a number of areas on which we could concentrate to maximise the potential supply of organs, to match them up effectively with potential recipients – most organs are not matches, unfortunately – and to carry out successful transplantations.

I believe that we need to ensure that the most appropriate infrastructure is in place to support organ donation and transplantation; to ensure that appropriate capacity and resources exist in our transplant hospitals to facilitate increased transplantation; to ensure that all those who die in circumstances where organ donation is a possibility are recognised and that their families are made aware of the possibilities of helping others; to build on the progress being made on the living kidney donor programme; and to strive to reach the point where organ donation will become the norm when opportunities arise.

This year, additional funding of almost €3 million has been provided to Organ Donation and Transplant Ireland, ODTI, which is part of the HSE, to facilitate the development of the most appropriate infrastructure to support organ donation and transplantation. The extra investment includes provision for the appointment of 19 whole-time-equivalent staff dedicated to organ donation and transplantation across the country.

Organ transplant can make an enormous difference to a patient, and to the lives of those around them. As Minister for Health, I am keen to ensure that we do all that we can to ensure that as many people as possible benefit from this gift of life. I can assure the House that every effort is being made to have all the necessary arrangements and protocols in place to facilitate St. Vincent’s being in a position to undertake pancreas transplants from mid-September, should a suitable donor-recipient match occur.

Senator Daly: It is a disappointing reply even on the practical matter of continuing to ask transplant candidates to attend emergency departments given that we know their very attendance could affect their health and lead to a catastrophic result for them. I understand the issue of staff not being available, but to continue to ask people to put themselves in harm’s way in a health service is deeply concerning.

I know this is the reply written up by the Minister, but it is the same reply that was written up for Senator Burke last week. It states that “[g]iven the logistical and time constraints involved, it is not practical to utilise the treatment abroad scheme”. Can the Minister imagine if he was on the organ donor list? He would have all the time in the world. He would go through hell and high water, all the logistical challenges and use all the time he had left to get treatment, whether at home or abroad. We do not have a surgeon for pancreatic transplants, we apparently do not know how many consultants are going to retire in our other organ donation areas and we will not even give patients the benefit of finding treatment abroad.

The Minister was not here when we recalled the Seanad to debate this issue, but having met people who are meeting for a life-or-death phone call, the simple act of telling them they must continue to go to emergency departments is a travesty. I know that is the reply we are given, but it is not even best practice. It is actually harmful. The least they could expect is that they would not be asked to do something that would harm them by their health service of all things.

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