Gino Kenny on cross-border cataract referrals and five-year waits

Thanks, Cahir Lock and good morning to all our guests. I just have a number of small, not small questions, but just I'm time limited because I have to speak in the chamber. And welcome to all our guests. Just in relation to the cross-border directive, is there kind of a calculation of how many people are availing of the cross-border directive? And obviously that has kind of slightly changed in the last 18 months because of Brexit and so forth, but is there a number that, you know, the doctors would have at hand that, you know, people are availing of this, of this, um, uh, directive? I'll take that. Um, thank you very much, uh, Deputy Kenny. Um, this, this is one area that does concern us because we don't have full visibility on the patients that are being referred directly out of the state to avail of the cross-border directive. Um, so, and obviously they're coming from all parts of the country and prior to the VSAs, we had made an assumption that the actual travel of patients from the nearest region that we talk about today was actually very low, but it comes from, um, when our colleague, Sean Paul Thieling, the voice of the customer with the referrers, we came to realise that large numbers of patients up to 20 a week from one optometric practice have been referred to Belfast for surgery. So this presents a problem for us in that we can't fully demand model. So how much capacity do we actually need? So we're basing on our current, uh, waitlist recurrent and demographic growth. We may need to bring more capacity in as we get a better idea of what the full demand is, but we've engaged with the optometrists and GPs in the region through this process. There's been really broad engagement or engagement and agreement that this is the right thing to do. In fairness to the referrers acting on best patients interest, they feel they can switch that system off till this is fully up and running. We're excited to be getting our new theatres so we can demonstrate that tripling of the capacity for cataract surgery to the matter, so they won't need to do it. But I do need to point out, I think this is often a misconception that the treatment abroad to Belfast are patients going up to an NHS unit to be treated up there. They're going to a private facility in Belfast. So we actually have the bizarre situation in another role where I do surgeries in the matter private hospital. I'm asked to operate on patients from Belfast, from the NHS services in Belfast, come south to Dublin for their surgeries. So there's an odd situation in the island where we've got patients from the Republic going to Belfast for surgery and patients from Belfast coming to Dublin for surgery. So again, through NERIS we're hoping that we provide enough capacity to this model that we will address our demand in our region and on the modelling and it's in the slide deck actually that I showed you there, Gerry Kelleher and Alison Dingle's modelling, is that we would actually hit that point in about three to four years' time and then we will have extra capacity to deal with the other parts of the country if they haven't addressed it themselves already by then. Would that be common, people coming from the north of Ireland down to the south? I can't speak for other private hospitals, I haven't gone specifically looking for that information and across other disciplines, but I do know that in areas like cardiothoracics and orthopaedics there'll be a lot of referrals down and more recently we've been asked to manage vitro retinal, so diabetic patients with hemorrhages, baccalauretinal detachments that have been referred back down to us and then more recently cataracts. But you've got to look at your capacity, so a lot of the work has not actually been taken on because you've got to look at the capacity and the way the HSE is deploying private hospitals at the moment to try and help with the public waitlist also and I know that's due to end shortly and so that the priority will be on the helping in that regard, but it's a sizeable enough number. I don't have the exact figures for you, Deputy, I can get those for what actually comes into matter of privacy through that route, but just as you're aware that pathway exists also back the other way. My final question was, a lady came into my office a number of weeks ago in relation to this very, very issue and I wouldn't really deal with that much in relation to consistency work, but she showed me the letter that she received back from um the HSE in relation to how long will she she'll be waiting for cataract surgery and this was a routine operation and I couldn't believe it what actually she showed me. She said in the letter that she'd be waiting up to five years for a routine appointment to see his pest list and it was obvious, you know I'm not a medical expert whatsoever, but it was obvious this woman is uh you know her deterioration of her eyes would seriously deteriorate uh well before them four or five years and I've obviously said to her look I think you gotta you couldn't wait that long you know and obviously you have to look at other um alternatives but I mean it's incredible that somebody has to wait up to that that period of time for a routine um appointment in relation to it to deteriorating um situation where I was I I couldn't agree with you more that that should not happen I mean that is the whole driving driving force behind this initiative that's how we've pulled the 200 stakeholders in the region to do it and I don't want to answer just with glib words to that in this day and age nobody should wait five years for an appointment to go and see a specialist so that's why our target is in the first year nobody will be waiting more than 12 months in our region we can only control what's on in our realm at the moment and even 12 months isn't good enough so we welcome the slaughter care goals of reducing that to less than three months in three years time and really our target is on-demand service care service delivery and we want to be judged at that level so and the impact and while the the vision impairment and blindness from cataract is reversible with surgery you can't escape the fact that an individual has to live let's unnecessarily in a first world country with a vision impairment or blindness as a result of that and that's why that's our purpose pyramid is to reduce that burden of vision impairment and blindness so with respect to cataract the sooner somebody sees a specialist the sooner somebody goes and gets their cataract surgery then we've achieved that goal that we lay down for ourselves so everything about that and if you did get a chance to read the presentation everything timely access to care reduced waiting list right patient right place right time transformation education all that all those pieces are our supports to ensure that we reduce the burden of vision impairment and blindness like you talk about that lady who came in to see you and um it is shocking but that's what drives this group yeah and dr keegan obviously in this situation what do you you know if somebody comes into my office or another tds office what do you say to somebody in relation to that situation where it's going to take five years for a routine upon um i have the letter in front of me but this is a routine kind of um just an appointment appointment alone will take five years what do you actually say to that person what do you advise well i'm surprised but one i would have retry out so one of the aspects that we're looking to do is the quality of letter that comes in and that's not to bounce back to the gp or the optometrist but what's been loud and clear from our work with the cataract team led by tim fulcher and lisa mckinane is when they worked at the standardized referral the gps really want the optometrist front and center and engaged on this with support from the gp services so that gives a more accurate referral coming in so you can risk stratify the referral coming in for starters that's not the full answer but then with that information you try out the urgency if somebody needs to be seen they've got comorbidities they might have diabetes as well or other issues or they may just have good vision in one eye with that and they should be expedited but really in this day and age five years there shouldn't be anybody waiting five years we the target is for for our i can only talk to our region deputy kenny and the target is to be down to less than 12 months by the end of the year for everybody and then i'm sorry the year after deployment and then within three years a zero to three month waitlist as an absolute and we are also and unfortunately patients are accessing care through the emergency services so we've got a disproportionate amount of patients accessing the emergency departments in the manor hospital the iron ear hospital cork or elsewhere around care that should be delivered through an outpatient setting so the first step i'd advise that lady is back to optometrist for gp a fresh letter in stating the urgency and just see that it's triaged appropriately i would hope and i'm more than happy to discuss with you or offline directly about that obviously we can't take all cases in but sometimes it's an index shocking case like that that drives change sometimes it shouldn't take it but we will we will react to that and we'll give an answer thank you very much thank you