As the dawn breaks on Saturday, in a petrol station in Bishopstown, Cork city, people with overnight bags patiently await a bus. Their destination, Belfast, lies a full 420km away, necessitating a round trip of 11 hours. For many, this will be their second such journey.
Among the passengers is Sean O’Regan from Goleen on the Mizen Head peninsula in West Cork who had to travel for two hours under the cover of the night to arrive at the pick-up point. For Julie Coldrick, a Welsh expatriate living on the Beara peninsula, the journey was slightly shorter at 1.5 hours. Their collective destination is the Kingsbridge Private Hospital in Belfast, reached via what is colloquially known as the ‘cataract bus’.
The service, beginning in Cork, carries separate patients across the length of Ireland to Northern Ireland for straightforward yet transformational cataract surgeries. The Government’s Health Service Executive (HSE) reimburses the costs of these operations. On Saturdays, the passengers are assessed and lodged at the same hotel. The surgeries occur the following day, making for a long Sunday, with the return to Cork scheduled for that night.
Initiated in 2017 by Michael and Danny Healy-Rae in their Kerry constituency, and Michael Collins TD in Cork, this service has been operational for years as a response to the extensive waiting lists for cataract operations in these counties. This Belfast trip marks the 166th ‘cataract bus’.
Over the past month, however, the journey’s smoothness has been jolted. In late August, the HSE mentioned a reduction in the reimbursements for external cataract care services from €1,681-€1,912 to slightly above €1,100, conditional upon the procedure. This rate change is fair, according to the HSE, as it aligns with the actual cost of the surgery.
Consequently, those who travelled on last Saturday’s bus faced additional costs of between €800 and €1,700, compared with those who utilised the service prior to the changes, introduced on September 1st.
Nevertheless, for some, there are no alternatives. Nora Foley, who undertakes her second journey to Belfast to have her second eye operation, states: “I can’t wait four months… I wouldn’t be able to drive in winter. My job would be at stake. I commute to Cork every day.”
According to the EU’s Cross Border Directive, such cataract surgeries are facilitated abroad.
Over the years since the introduction of bus service, there has been a significant increase in the national health budget, going from €14 billion in 2017 to €23.5 billion presently. Despite this, numerous individuals still have to travel far for healthcare services.
In the words of Collins, the TD for South-West Cork, finding a suitable healthcare facility in Cork or Kerry that could alleviate the long waiting lists sounds as difficult as locating Caesar’s Palace. He highlighted that simple procedures like cataract surgeries are undertaken in a tent in Ethiopia, a ship in India, or a shopping centre in Luton, indicating that all it requires is a room with the necessary equipment and staff.
A group of 23 people set off for Belfast – among them, 12 are patients and their 11 accompanying persons. The prevalent emotion is a mix of relief at finally accessing this crucial surgery and frustration about the need to travel so far.
O’Regan, who is facing my direction, states, “I can’t see you at the moment.” His GP in Skibbereen had marked him as a priority. However, he fails to understand why the procedure cannot be conducted in Cork.
Residing in Doneraile in north Cork, Catherine McCarthy, aged 43, is considered relatively young to develop cataracts. In her case, it’s a genetic condition. She is a mother of two and holds a position in data processing, but currently, she is unable to drive after dark.
McCarthy would have to take a leave of sickness from work and apply for illness benefits if she decided to wait six months for an appointment in Cork. Her out-of-pocket expenses for both eyes is expected to be around €5,200, and she will be able to recoup approximately half of this cost.
She conveys her disappointment, stating that she adhered to all the norms and even purchased private health insurance. But the cataract issue developed too swiftly for her to react. McCarthy has already undergone surgery for one eye as per the old reimbursement policy while opting for the new scheme for the other eye.
In her words, “It’s absolutely needless. I’ve abided by all the regulations. I have my own health insurance. The cataract condition developed too quickly.” Frustrated, she questions why she should pay for private health insurance when she is forced to pay money for this service.
74-year-old Raymond Heffernan believes it’s either Belfast or potential blindness for him. He credits Michael Collins’ bus service, arguing without it, numerous individuals may lose their sight. He stresses his own predicament would be navigating with a guide dog and a cane, calling the entire situation utterly horrendous.
Heffernan points out the €14 billion in unpaid taxes by American tech behemoth Apple that the European Union has demanded, alongside the overflowing corporate tax revenue in the national coffers. Many co-passengers share the sentiment: why can’t basic medical procedures be financed under the Irish healthcare system?
Collins is scheduled to ferry another group of passengers to Belfast over the weekend, filled with individuals having orthopaedic surgery for their hips and knees. 22 patients have so far confirmed their slots.
Collins strongly criticises the Health Service Executive for failing the Irish population. He cites the examples of people from Dublin, Galway, and elsewhere who are enduring pain and cannot afford to wait. “Their bodies are aching and deteriorating — it’s bone rubbing against bone. There’s no end to it,” he comments.