The ‘Belfast or Blind’ bus has made 167 trips to Northern Ireland from Cork and Kerry since 2017, bringing people across the border for vital cataract surgery. The alternative for many of these people would be to face very long wait times.
The sight-restoring operation is carried out under the Northern Ireland Planned Healthcare Scheme (NIPHS) and two more trips are currently planned.
The idea for the bus took shape in 2016, when TDs Michael Collins, Cork southwest, and Danny Healy-Rae, Kerry, realised that people from the Republic of Ireland could travel north for this operation and have much of the cost refunded under what was then called the EU Cross Border Directive.
“I met Mark Regan from Kingsbridge Healthcare Group at the National Ploughing Championships,” explains Deputy Collins, and learned about the (then EU Cross Border Directive) scheme. I was at the early stages of my Dáil career and I had quite a lot of people who were almost blind approaching me about cataract operations. I was trying to help (get them into hospitals in Cork), but I couldn’t.
“After a meeting with the hospital, Danny found eight constituents in Kerry for the first bus and I found eight. It exploded from there.”
That was in early 2017. The scheme was retained after Brexit and is now called the NI Planned Healthcare Scheme (NIPHS). The cross-border travel has continued due to lengthy waiting lists in the 26 counties. A total of 6,141 patients were awaiting cataract surgery at the end of August this year.
Gradual sight loss
Developing a cataract in one or both eyes means that the lens in your eye becomes cloudy, so seeing becomes gradually more difficult. As well as blurred vision, symptoms can include difficulty driving at night, glare from headlights, lamps and the sun, and seeing a halo around bright lights.
The surgery removes the old cloudy lens and replaces it with an artificial one, giving patients their sight back, as well as their quality of life.
“We have carried out over 6,500 cataract surgeries since the schemes began,” says Mark Regan, CEO of the Kingsbridge Healthcare Group.
“That’s approximately 1,000 a year under the NIPHS, at the four hospitals in our group.”
Other hospitals in Northern Ireland also provide this surgery, but the buses organised by the TDs travel to Kingsbridge hospitals. The operation currently costs £2,095 (€2,515) per eye.
Since 1 September, cataract patients get a refund of €1,171 towards the cost of the surgery from the HSE within six weeks. However, prior to that €1,456 was refunded. That’s a cut of €285 per eye operation. With many people having to get both eyes done, it’s nearly a €600 shortfall on what was paid before September.
So why was the funding cut? The HSE, in a long explanation, says that pricing of procedures hadn’t been updated for some time due to COVID-19.
All procedures have now been reclassified according to an Australian modelled, international coding system. The HSE is only obliged to pay those who travel to NI under the scheme, the same amount as it pays its own hospitals for cataract surgery in the Republic – a figure of €1,171 – hence the refund figure.
“The cost of the most common cataract procedure has reduced to €1,171 in 2024 from €1,456 in 2023,” a HSE statement explains. “The cost of the equivalent cataract procedure in the public NHS system is £766 (€919). We understand, however, that NI providers are charging well in excess of this.”
Extra bus loads went to Belfast in August this year, ahead of the reimbursement cuts, and while interest slackened off for a while, numbers have picked up again, according to Deputy Collins.
Cork TD Michael Collins helped establish the ‘Belfast or Blind’ bus service.
“People have two choices, it’s either go – or go blind. They are telling me ‘we are going to have to find the money somewhere, because we’ll still be waiting between three and five years down here in the Cork/Kerry area for cataract surgery’,” he adds.
Patients either borrow from family or fund the shortfall. Many people look towards their local credit union for a loan. “The credit unions are great. They’ll still give you the loan, but now you only get €1,171 back, so that means you’ve to find more money to meet the shortfall.”
The HSE points out that patients waiting a long time are being treated under the National Treatment Purchase Scheme.
“For 2024, the NTPF has approved six Insourcing Cataracts initiatives, which will facilitate treatment for 3,315 patients on the cataract waiting lists,” a spokesperson said.
“The NTPF has also approved five Insourcing Ophthalmology Outpatient initiatives so far in 2024, which will provide 6,295 additional appointments for patients on ophthalmology waiting lists.”
Insourcing means providing additional capacity (getting more operations done) within some public hospitals so that waiting lists are reduced.
Outsourcing is procuring capacity in a private hospital (paying private hospitals to do the operations), again to reduce waiting lists.
“While the number of patients on the waiting list for cataract procedures nationally has increased since the end of 2023, the number of patients waiting over 12 months has reduced in the same period,” Minister for Health Stephen Donnelly told the Dáil.
A new ophthalmology unit for the Cork and Kerry area was officially opened by Tánaiste Micheál Martin in the South Infirmary Victoria University Hospital in Cork on Monday, 21 October.
The unit will deal with all planned and emergency ophthalmology services from Cork University Hospital and the Mercy University Hospital.
The Tánaiste hopes the unit will, in time, bring an end to the Belfast bus service. The new Cork unit is expected to care for 45,000 patients a year.
Seán O’Regan’s story
Seán O’Regan pictured on the bus to Belfast.
Seán O’Regan lives in the village of Goleen, near Mizen Head in west Cork. Prior to surgery this August, he had 10% sight in his left eye and 50% in his right.
“From where I live, I have a view of the sea on one side and the mountains on the other, but they were all a blur,” he says.
Seán was told by doctors in Cork that he needed cataract surgery on both eyes. He was also informed that, because of long waiting lists, it would be six to nine months before he would see a surgeon and two to three years before he would get the surgery.
“It got to the stage where I couldn’t work at garden maintenance anymore because I couldn’t see, so I called into Deputy Collins’ constituency office, having heard about the bus to Belfast.
"That was a Wednesday in August and I was on the bus the following Saturday morning. A month later I took the bus again to get the second one done. It’s unbelievable. I can see the sheep on the mountains again.”
When Irish Country Living spoke to Seán, he was awaiting reimbursement for both operations.
“I paid £2,500 (€3,002 approximately) in total each time. This includes the bus and overnight accommodation, the assessment, the anaesthetist cost and the operation. I’ll get back €1,456 for the first operation before the end of August and only €1,171 for the second, because of the cuts.”
However, Seán speaks highly of his overall experience.
“It’s a whole new beginning. Everybody was great, the hospital had it down to a tee, but only for Deputy Collins, this part of Ireland would be totally neglected. The operation itself only took 15 minutes and it wasn’t painful. Two hours later you’re on the bus home. Why can’t hospitals down here do that? The system here is broken.”
For more information about this scheme, visit 2.hse.ie/services/schemes-allowances/ niphs; kingsbridgehealthcaregroup.com.
The following clinics outline the costs for a person without private health insurance who wants to pay for the operation.
The Cork Eye Clinic states that it would cost €2,731 per eye, done on a day-case basis. Prices vary at opticalexpress.ie depending on the prescription you require. For example, it is €3,195 for monofocal (vision correction) and more if you want multifocal lenses (distance and near vision corrected). Blackrock Health Galway did not make its price available.Cataract surgery is also carried out in UPMC hospitals. The price quoted is €2,383 with local anaesthetic, and €2,598 with general anaesthetic. Read more
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The ‘Belfast or Blind’ bus has made 167 trips to Northern Ireland from Cork and Kerry since 2017, bringing people across the border for vital cataract surgery. The alternative for many of these people would be to face very long wait times.
The sight-restoring operation is carried out under the Northern Ireland Planned Healthcare Scheme (NIPHS) and two more trips are currently planned.
The idea for the bus took shape in 2016, when TDs Michael Collins, Cork southwest, and Danny Healy-Rae, Kerry, realised that people from the Republic of Ireland could travel north for this operation and have much of the cost refunded under what was then called the EU Cross Border Directive.
“I met Mark Regan from Kingsbridge Healthcare Group at the National Ploughing Championships,” explains Deputy Collins, and learned about the (then EU Cross Border Directive) scheme. I was at the early stages of my Dáil career and I had quite a lot of people who were almost blind approaching me about cataract operations. I was trying to help (get them into hospitals in Cork), but I couldn’t.
“After a meeting with the hospital, Danny found eight constituents in Kerry for the first bus and I found eight. It exploded from there.”
That was in early 2017. The scheme was retained after Brexit and is now called the NI Planned Healthcare Scheme (NIPHS). The cross-border travel has continued due to lengthy waiting lists in the 26 counties. A total of 6,141 patients were awaiting cataract surgery at the end of August this year.
Gradual sight loss
Developing a cataract in one or both eyes means that the lens in your eye becomes cloudy, so seeing becomes gradually more difficult. As well as blurred vision, symptoms can include difficulty driving at night, glare from headlights, lamps and the sun, and seeing a halo around bright lights.
The surgery removes the old cloudy lens and replaces it with an artificial one, giving patients their sight back, as well as their quality of life.
“We have carried out over 6,500 cataract surgeries since the schemes began,” says Mark Regan, CEO of the Kingsbridge Healthcare Group.
“That’s approximately 1,000 a year under the NIPHS, at the four hospitals in our group.”
Other hospitals in Northern Ireland also provide this surgery, but the buses organised by the TDs travel to Kingsbridge hospitals. The operation currently costs £2,095 (€2,515) per eye.
Since 1 September, cataract patients get a refund of €1,171 towards the cost of the surgery from the HSE within six weeks. However, prior to that €1,456 was refunded. That’s a cut of €285 per eye operation. With many people having to get both eyes done, it’s nearly a €600 shortfall on what was paid before September.
So why was the funding cut? The HSE, in a long explanation, says that pricing of procedures hadn’t been updated for some time due to COVID-19.
All procedures have now been reclassified according to an Australian modelled, international coding system. The HSE is only obliged to pay those who travel to NI under the scheme, the same amount as it pays its own hospitals for cataract surgery in the Republic – a figure of €1,171 – hence the refund figure.
“The cost of the most common cataract procedure has reduced to €1,171 in 2024 from €1,456 in 2023,” a HSE statement explains. “The cost of the equivalent cataract procedure in the public NHS system is £766 (€919). We understand, however, that NI providers are charging well in excess of this.”
Extra bus loads went to Belfast in August this year, ahead of the reimbursement cuts, and while interest slackened off for a while, numbers have picked up again, according to Deputy Collins.
Cork TD Michael Collins helped establish the ‘Belfast or Blind’ bus service.
“People have two choices, it’s either go – or go blind. They are telling me ‘we are going to have to find the money somewhere, because we’ll still be waiting between three and five years down here in the Cork/Kerry area for cataract surgery’,” he adds.
Patients either borrow from family or fund the shortfall. Many people look towards their local credit union for a loan. “The credit unions are great. They’ll still give you the loan, but now you only get €1,171 back, so that means you’ve to find more money to meet the shortfall.”
The HSE points out that patients waiting a long time are being treated under the National Treatment Purchase Scheme.
“For 2024, the NTPF has approved six Insourcing Cataracts initiatives, which will facilitate treatment for 3,315 patients on the cataract waiting lists,” a spokesperson said.
“The NTPF has also approved five Insourcing Ophthalmology Outpatient initiatives so far in 2024, which will provide 6,295 additional appointments for patients on ophthalmology waiting lists.”
Insourcing means providing additional capacity (getting more operations done) within some public hospitals so that waiting lists are reduced.
Outsourcing is procuring capacity in a private hospital (paying private hospitals to do the operations), again to reduce waiting lists.
“While the number of patients on the waiting list for cataract procedures nationally has increased since the end of 2023, the number of patients waiting over 12 months has reduced in the same period,” Minister for Health Stephen Donnelly told the Dáil.
A new ophthalmology unit for the Cork and Kerry area was officially opened by Tánaiste Micheál Martin in the South Infirmary Victoria University Hospital in Cork on Monday, 21 October.
The unit will deal with all planned and emergency ophthalmology services from Cork University Hospital and the Mercy University Hospital.
The Tánaiste hopes the unit will, in time, bring an end to the Belfast bus service. The new Cork unit is expected to care for 45,000 patients a year.
Seán O’Regan’s story
Seán O’Regan pictured on the bus to Belfast.
Seán O’Regan lives in the village of Goleen, near Mizen Head in west Cork. Prior to surgery this August, he had 10% sight in his left eye and 50% in his right.
“From where I live, I have a view of the sea on one side and the mountains on the other, but they were all a blur,” he says.
Seán was told by doctors in Cork that he needed cataract surgery on both eyes. He was also informed that, because of long waiting lists, it would be six to nine months before he would see a surgeon and two to three years before he would get the surgery.
“It got to the stage where I couldn’t work at garden maintenance anymore because I couldn’t see, so I called into Deputy Collins’ constituency office, having heard about the bus to Belfast.
"That was a Wednesday in August and I was on the bus the following Saturday morning. A month later I took the bus again to get the second one done. It’s unbelievable. I can see the sheep on the mountains again.”
When Irish Country Living spoke to Seán, he was awaiting reimbursement for both operations.
“I paid £2,500 (€3,002 approximately) in total each time. This includes the bus and overnight accommodation, the assessment, the anaesthetist cost and the operation. I’ll get back €1,456 for the first operation before the end of August and only €1,171 for the second, because of the cuts.”
However, Seán speaks highly of his overall experience.
“It’s a whole new beginning. Everybody was great, the hospital had it down to a tee, but only for Deputy Collins, this part of Ireland would be totally neglected. The operation itself only took 15 minutes and it wasn’t painful. Two hours later you’re on the bus home. Why can’t hospitals down here do that? The system here is broken.”
For more information about this scheme, visit 2.hse.ie/services/schemes-allowances/ niphs; kingsbridgehealthcaregroup.com.
The following clinics outline the costs for a person without private health insurance who wants to pay for the operation.
The Cork Eye Clinic states that it would cost €2,731 per eye, done on a day-case basis. Prices vary at opticalexpress.ie depending on the prescription you require. For example, it is €3,195 for monofocal (vision correction) and more if you want multifocal lenses (distance and near vision corrected). Blackrock Health Galway did not make its price available.Cataract surgery is also carried out in UPMC hospitals. The price quoted is €2,383 with local anaesthetic, and €2,598 with general anaesthetic. Read more
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