To the cream cracker, the rasher and the cheese-and-onion crisp, we should add another great Irish invention: the cataract bus. For if you want to get the full flavour of this mad island, chew on this strange fruit of carelessness and clientelism.
The removal of cataracts is one of the oldest and simplest of surgical procedures, going back to ancient Greece. It does not even require a general anaesthetic – a few eye drops usually suffice. It is also, if we compare the time and effort involved to the transformative effect on a patient’s life, surely the single most efficient health intervention. It takes less than half an hour to perform, but it stops people going blind. That’s quite some ratio of inputs to outputs.
Alongside the immense benefits to the individuals concerned, cataract surgery also saves the State a fortune. Impaired vision has a dire impact on the health of older people. It leads to falls and injuries. It contributes to cognitive decline and social isolation. It makes it harder for people to take exercise – even to go for a walk.
If you want to build up costs for the health service, delaying cataract surgeries is a perfect formula for increasing the downstream costs of future hospitalisations. As well as the preventable misery, this has entirely predictable consequences for the public finances.
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Official figures show that, as of last March, 4,010 people aged over 70 were on waiting lists for cataract surgery, with 314 in the queue for more than a year, including 97 waiting more than 18 months. Of these, 1,803 were at hospitals in Dublin, 552 in Waterford, 354 in Limerick, 307 in Sligo, 300 in Cork and 268 in Galway.
All of this is fixable. Nenagh Hospital, for example, set up a dedicated twice-monthly cataract clinic in July 2022. Before it was established, there were 647 patients on the waiting list for cataract operations and the average waiting time was a disgraceful two to four years. As of last March, the waiting list was reduced to 131; 90 per cent of attendees were having their surgery within four months; and the number waiting more than 12 months had fallen to 10. If this can be done in Nenagh, it can be done everywhere. But perhaps one of the reasons it has not happened is that those with the loudest voices – people with money – can buy their way out of impending blindness.
You can, of course, get the operation done quickly – if you have the money. Private operators such as Optical Express advertise cataract surgery “from only €3,195 per eye” – a minimum of €6,390 for both. “You could experience the joy of being able to see clearly in the morning from the moment you wake up. You could read or watch television without any effort ... and we haven’t even scratched the surface of how your life could change.”
Private hospitals and clinics actually leverage the misery of the public waiting lists as one of the selling points for their services. “No need to wait months to restore your sight,” declares Kingsbridge Private Hospital in Sligo. “Skip the waiting list for cataract surgery to correct blurred vision.” The Cathedral Eye Clinic in Belfast runs this headline on its website: “Munster patients skip long waiting times for treatment”. In this marketplace for basic healthcare, inequality is not a bug, it’s a feature.
And in to this arena of public failures and private profits, enter the Irish solution to Irish problems: clientelism. Just as the waiting lists for cataract surgery create a commercial opening, they also create a political opportunity. To go back for a moment to the Cathedral Eye Clinic website, it does not advertise only the expertise of its medical director Prof Johnny Moore. It also blazons the beneficence of another great medical mind: the Independent Kerry TD Michael Healy-Rae.
It has always seemed to me to be rather telling that TDs call their consultations with constituents “clinics” or “surgeries”. But this metaphor has become literal. Healy-Rae is presented by Cathedral Eye Clinic as the surgeon’s first mate, the man who, along with the doctor, will make the blind see.
Here’s Cathedral’s pitch: “Thousands of residents in Munster can be waiting for years to have cataract surgery – but many of them don’t realise they can have their sight restored in just a few weeks, thanks to a HSE scheme, Belfast’s Cathedral Eye Clinic and Deputy Michael Healy-Rae.” Yes, it literally says you can have your sight restored “thanks to” a TD.
Even more bizarrely, the prospective patient is urged to call a phone number to arrange treatment: 064-6685782. But hang on a minute, 064 is not a Belfast code. It’s for Killarney, Kenmare, Sneem and Kilgarvan – Healy-Rae country. The phone number is actually for Healy-Rae’s constituency office. As the TD himself declares on the Cathedral Eye Clinic website: “I encourage anyone waiting for a cataract to be removed to contact us and we’ll have you seen in a matter of weeks. We’ll arrange everything.”
This is, in its way, a brilliant bit of political entrepreneurship. (Another Independent TD, Michael Collins, operates the cataract bus from Cork.) It funnels public money into a lucrative business, but it also makes the politician into a personal saviour, Jesus in a cloth cap. In the Bible story of the Saviour’s miracle, the now-sighted blind man reports to the Pharisees: “He put mud on my eyes and I washed, and now I see.”
Well, here’s mud in our eyes. Healthcare is a right. We, the public, pay for all these treatments. But the inadequacies of public delivery open a gap between rights and realities. And in that gap, a basic entitlement (not being left to go blind) becomes a favour bestowed “thanks to” the TD. Gratitude will express itself in the polling booth.
The purpose of cataract surgery is to remove a lens that has become clouded and enable a person to see properly. But the cloudy lens of clientelism still blurs the vision that Irish citizens have of their democratic rights.