It’s 6am on a balmy autumn Saturday at a filling station in Bishopstown in Cork City. Passengers with overnight suitcases are waiting patiently for a bus to take them to Belfast, a distance of 420km and an 11-hour return trip. Many have to make the journey twice.
Sean O’Regan, from Goleen on the Mizen Head peninsula in west Cork, has had to travel two hours through the night to get here. It was a 1½-hour journey for Julie Coldrick, a Welsh woman living on the Beara Peninsula. Their final destination will be the Kingsbridge Private Hospital in Belfast. Welcome aboard the cataract bus, as they call it.
The passengers stay in the same hotel and are assessed on Saturday. The eye operations take place on Sunday, which will be a long day as they are due to arrive back in Cork on Sunday night.
This is the 166th cataract bus to depart for Northern Ireland. The service has been running for years, having been started in 2017 by TDs Michael and Danny Healy-Rae in their Kerry constituency and Michael Collins TD in Cork, to remedy the long waiting list for cataract operations in their counties.
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The bus transports patients from one end of the island to the other for a straightforward but life-changing operation in Northern Ireland for which the Health Service Executive reimburses the costs.
However, the journey has become bumpier for the passengers over the past four weeks. At the end of August, the HSE said the reimbursement for cataract services outside the State would decrease from €1,681-€1,912 to just over €1,100, depending on the procedure. This, the HSE claims, is in line with the actual costs of the operation.
Passengers on last Saturday’s bus are paying €800-€1,700 more for the service than those who travelled before the changes in reimbursements were introduced on September 1st.
They have no alternative. “I can’t wait four months,” says Nora Foley, who is making a second trip to Belfast to have her second eye done. “I wouldn’t be able to drive in winter. My job would be gone. I drive to Cork every day.”
The cataract surgeries are made possible under the EU’s Cross Border Directive, which facilitates healthcare outside the jurisdiction.
In the years since the bus started running, the State health budget has increased from €14 billion in 2017 to €23.5 billion this year, yet many still have to travel for healthcare.
“You’d swear I was looking for Caesar’s palace,” says Collins, TD for Cork South-West, in reference to the oft-repeated excuse to him that there is no suitable facility in Cork or Kerry to bring an end to the long waiting lists.
“You can have cataract surgery in a tent in Ethiopia, you can have it off a ship in India, you can have it in a shopping centre in Luton. All you need is a fully equipped room with staff,” he says.
The general mood among the 23 passengers travelling to Belfast – 12 are getting operations and they have 11 companions – is one of relief at the fact they are finally getting this vital surgery, albeit coupled with exasperation that they have to go such a distance to get it.
“I can’t see you now,” says O’Regan, staring straight in my direction. “My doctor [in Skibbereen] told me I was a priority case. Why can’t they do it in Cork? It makes no sense to me.”
At 43, Catherine McCarthy, from Doneraile in north Cork, is young to have cataracts. It’s a hereditary condition in her case. She has two young children, works in data processing and cannot drive at night at present.
Were she to wait for an appointment in Cork, which takes an average of six months, she would have to sign off from work sick and claim illness benefit. The upfront cost she faces for both eyes is €5,200, about half of which she will be able to recoup.
“It’s so unnecessary,” she says. “I have done everything right. I have private health insurance. It came on me very fast.”
McCarthy had the procedure on one eye under the old reimbursement scheme and the second under the new scheme.
“It’s heartbreaking. Why am I paying private health insurance? It defeats the whole purpose if I have to pay cash to have this done,” she says.
Raymond Heffernan (74) says it’s Belfast or blindness for him. “Only for Michael Collins running these buses, there would be a lot of people going blind,” he says. “I’d be going around with a white dog and a stick. It’s an utter disgrace.”
He mentions the €14 billion in back-taxes that the EU has ordered US tech giant Apple to pay Ireland and the fact that the State coffers are awash with corporation tax revenue. A common view among passengers on the bus is: why can this basic surgery not be provided through the Irish health system?
Collins is bringing another bus to Belfast this weekend, carrying people having knee and hip procedures. There are 22 patients booked on.
“The HSE is failing people in this country. I’m getting people from Dublin, Galway and other places who are in pain and can’t wait,” he says. “They are grinding and cracking. It’s bone to bone. I could go on forever.”
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