Visit of Minister of Health, Leo Varadkar, TD to the Hospital, November 11th 2015
Address by Patrick Dowling, President of Council, Royal Victoria Eye and Ear Hospital
Minister Varadkar, you are most welcome to the Royal Victoria Eye and Ear Hospital. That
you have chosen to come here we take as your recognition of the first class patient care
which has been provided by the nurses, doctors and management of the Hospital under
what have been difficult conditions over the years of cutbacks. We very much appreciate
your presence and support.
As you probably know the RVEEH was founded by Oscar Wilde’s father William Wilde in
1897. Today the Hospital receives some 100,000 patient visits a year (the equivalent of a
full Lansdowne Road stadium every six months). Ophthalmology accounts for some 80% of
visits and ENT 20%. The Hospital is essentially a day care Hospital with few overnight
stays.
As a hospital we tend to keep a low profile and out of the newspapers, perhaps due to the
fact that we operate within budget!
We remain true to the ethos of our founders as a not for profit Hospital whose sole agenda is
to provide the best possible care for our patients.
We are very proud of the fact that we are one of only two public hospitals in Ireland with
international JCI Accreditation.
In addition to adult patients the Eye and Ear has a long tradition in providing paediatric
Ophthalmology and ENT care. The RVEEH carries out as much Ophthalmology & ENT
surgery as do the major paediatric hospitals, a fact not often acknowledged.
The hospital is currently engaged with the National Children’s Hospital to address waiting
lists for tonsillectomy and grommet surgery. In addition the hospital is working with the HSEs
National Clinical Lead in audiology on expanding the hospital’s audiology service to facilitate
paediatric referrals from primary care on the south-side of Dublin.
The RVEEH was built and funded by donations from the people of Dublin. We are very
conscious of this tradition of self-help and indeed the Education and Conference Centre
building in which we are standing was built and funded by private donations.
On the theme of private donations, I would like to acknowledge two significant patient
donations which we have received in recent months. One patient who had successful
complex eye surgery has purchased €120,000 of surgical equipment and donated it to the
Hospital. The donor wishes to remain anonymous but I would like to say a big go raibh
maith agat to him in public.
The second donation also from a patient, will fund research at the Hospital’s Research
Foundation in an amount of €500,000. As a teaching Hospital connected to UCD, Trinity
and RCSI, research is important to the reputation of the Hospital as a National Centre, for
ensuring that our patient’s receive the most advanced clinical treatment and that we attract
the best students and consultants. We are enormously grateful to Mrs Terry Claxton for this
generous support.
Minister, you are probably aware that a National Eye care Plan for Ireland was completed in
2014 by Mr Paul Moriarty under the auspices of the HSE and the Irish College of
Ophthalmologists. Inter alia the report recommended the realignment of ophthalmic
services from acute setting towards community care.
As the National Ophthalmic Centre we felt that it was incumbent on us to respond to the
recommendations of the report and to that end Council and Medical staff have spent the last
12 months developing an Ophthalmic Strategy for the RVEEH for the period 2015 to 2025.
In creating the Strategy we paid particular attention to best practice at the world’s leading
Eye Hospitals, Massachusetts Eye and Ear, Wills Eye in Philadelphia, Moorfields in London
and Royal Victorian Eye and Ear in Melbourne.
We noted that all are stand-alone Hospitals and not located on a general Hospital campus.
This means that theatre access can be planned with a high degree of certainty both for
Ophthalmology and ENT.
We visited Moorfields Eye Hospital in London and personnel from there visited us.
The elements of their operation which particularly impressed us was the Hub and Spoke
model which connected their main Hospital with satellite units/Hospitals in the greater
London community. By the way their main hospital is located in a building 75 years older
than this one.
Let me give an example of why the Hub and Spoke model might have resonated with us.
We have a long standing relationship with Portlaoise Hospital. They send patients by bus to
here. For a typical cataract operation the patient will come to Dublin four times. With a
satellite unit (2,500 sq ft) and appropriate IT connection, the initial appointment, pre-op
assessment and post op assessment could all be done in Portlaoise and the patient would
only come here once for the cataract operation.
I use Portlaoise as an example but this could be done at Wexford, Tullamore, Kilkenny and
Primary Care Units. We are working with the Primary Care Unit of the HSE to establish
community ophthalmic satellite centres and would like to advance this project if funding
support were available. This template of Hub and Spoke under the clinical directive of the
Hub could be rolled out nationally and there is no reason the RVEEH could not have several
of these satellite units operational in 2016.
The second leg of our Strategy is to put in place a dedicated Cataract Unit in what is now an
administrative area of the Hospital.
You will know that there is an explosion in demand for cataract operations as a result of the
aging Irish population. A dedicated Cataract Unit would process very efficiently 3,000
operations a year in addition to the 2,500 we currently do. At present 14,000 cataract
operations are done nationally. This dedicated cataract unit would eliminate cataract waiting
lists at this Hospital and probably at other Hospitals also which feed into us. We have
submitted a planning application to Dublin City Council and could have the new unit
operational by the first half of 2016.
Returning to my earlier theme of self-help, the Hospital would NOT seek funding from the
HSE for the capital cost of the Cataract Unit. The Royal Victoria Eye and Ear Hospital
Teaching and Development Foundation will fund the capital cost of approximately €1 million.
The operational cost of the dedicated Cataract Unit would need to be allocated from
Government for the project to proceed.
While eye care constitutes less than 1.5% of Ireland’s healthcare budget, the economic
costs of not treating eye disease are very well documented and are many multiples of the
eye care health expenditure in Ireland. Money spent on eye care pays a huge dividend in
avoiding the costs associated with caring for those with sight problems and consequent loss
of independence.
The Ophthalmic Strategy 2015-2025 for the Hospital seeks to put in place structures, the
Hub and Spoke model, to deal with the long term issues of rising demand while at the same
time dealing with short term issues of waiting lists through the dedicated Cataract Unit. Both
structures, long and short, are capable of being up and running in 2016.
We believe that the hospital’s Strategy for Ophthalmology is a sensible low cost approach,
capable of being implemented immediately and will avoid patients developing irreversible
sight deterioration while waiting for access to cataract, glaucoma and AMD operations. We
are confident that with the support of the Minister, his officials and our colleagues at the HSE
and Ireland East Hospital Group we can quickly deliver on our Strategic Plan and would ask
the Minister to support us in our endeavours.
In conclusion, Minister, we are very grateful for your visit and appreciate that despite holding
what must be a most demanding portfolio in Government, that you have given of your time to
come here today.