James Reilly (Dublin North, Fine Gael) | Oireachtas source

I thank the Chairman and members of the committee for inviting me here today to discuss the closure of Mount Carmel Hospital.

I recognise fully that the loss of the hospital has come as a blow and, to some, a shock. It created some uncertainty for patients and prospective patients, and the HSE stepped in quickly to ensure a seamless transfer to other maternity services where required. Understandably, it has been difficult for staff to come to terms with job losses, particularly those who have spent the best part of their careers working at the hospital. I acknowledge that and, on a personal level, I am disappointed that a suitable buyer could not be found for the hospital. However, let me be clear that a State purchase of the hospital as a going concern was never a viable option.

Following an approach from NAMA, my Department undertook a high level examination in order to assess the feasibility of HSE purchase of the hospital. It immediately became clear that the purchase of Mount Carmel, as a standalone low-volume hospital, would be contrary to Government policy on maternity services. Current Government policy on maternity services is based on the premise that for optimal clinical outcomes, maternity services should be co-located with adult acute services or tri-located with adult and paediatric services. The benefits of co-location and tri-location are clear and accepted internationally. Co-location allows the mother access to a full range of medical and support services should the need arise, such as cardiac and vascular surgery, intensive care facilities, haematology services and psychiatric services. Tri-location ensures immediate access on-site to paediatric services when foetal or neonatal surgery or other interventions are required. The availability of these services helps ensure the delivery of an optimum safe service for mothers and their babies.

I assure the committee that Government policy on maternity services is evidence based. The model of stand-alone maternity hospitals is not the norm internationally and is no longer recognised as international best practice for future service development. Where other countries have reconfigured, the move has been to co-location and tri-location. In Ireland too, we are moving in that direction. Last May, I announced the Government's intention to relocate the National Maternity Hospital, Holles Street, to the St. Vincent's University Hospital campus at Elm Park. We also propose to provide a new maternity hospital on the St. James's campus, alongside the new children's hospital, and thus we will have a tri-located maternity, adult and pediatric facility. In the context of our move to the provision of bi-located and tri-located facilities, the acquisition of Mount Carmel as a stand-alone maternity hospital would represent a retrograde step.

I should also put on record my reservations regarding the low volume of births in the hospital. Best practice, and the development of excellence in patient care and safety, is predicated on a high volume of patient throughput. On the international front, there has been a clear move to close smaller maternity units and consolidate services into larger hospitals. As a doctor and as Minister for Health, my primary concern must be the provision of safe high-quality care to patients. Patient safety issues are issues on which we will not compromise. I assure the committee that the provision of maternity services in a small stand-alone maternity hospital or in a maternity unit within a non-acute setting does not constitute best practice or represent safest practice, and clearly does not provide the level of safety and quality that our patients need and deserve.

In considering the option to purchase Mount Carmel as a going concern, my officials examined the potential impact of the closure of the hospital on maternity service capacity in the greater Dublin area. The reality is that there has been a significant reduction in birth rates in Dublin, and in the rest of the country, in recent years. It is also relevant that the Central Statistics Office, CSO, projects that birth rates will continue to fall, at least until the early 2020s.

The latest draft information available from the HSE indicates that there were 25,877 births in the three Dublin publicly funded hospitals in 2013. Since the peak in Dublin in 2010, the number of births in Dublin public hospitals has reduced by over 1,900 births. In Mount Carmel in 2012, the most recent full year for which figures are available, there were 1,323 births, some of which were from outside the Dublin area. Thus, we can be confident that our maternity services have the capacity to deal with the additional demands on their services arising from the closure of Mount Carmel. This is borne out by the fact that within hours of the announcement regarding the liquidation of Mount Carmel, the three Dublin maternity hospitals made it clear that they had the capacity to treat maternity patients who had planned to give birth in Mount Carmel and invited mothers to be to contact them to arrange their transfers.

As Minister, I have responsibility to the taxpayer to ensure public money is used prudently. In view of the evidence of falling birth rates and the consequent falling demand for maternity services, allied to the need to provide maternity services where possible in co-located or tri-located hospitals, I am firmly of the view that the purchase of Mount Carmel as a going concern cannot be justified. Any available funding would be more appropriately used to resource our current maternity services to enable them to continue to provide safe, high-quality services rather than acquire a facility whose operation would be contrary to Government policy. There may, of course, be other potential uses for the hospital - for example, as a step-down facility or a short-term transitional facility for older people – and these options may be worth exploring. However, if we want to acquire the hospital for other such purposes, it would not make sense to purchase it as a going concern because, by so doing, we would expose the HSE to all contingent liabilities.

My Department, in conjunction with the HSE, is currently developing a national maternity strategy. This will provide the strategic direction for the optimal development of our maternity services to ensure that women have access to safe, high-quality maternity care in a setting most appropriate to their needs. Developing the strategy will provide us with the opportunity to take stock of current services and identify how we can improve the quality and safety of care provided to pregnant women and their babies. The strategy will ensure that, in the future, our services will be fit for purpose and in accordance with best available national and international evidence.

It would be unwise in advance of considerations regarding the future models of maternity service provision to make any decisions on maternity service capacity in any part of the country. I am aware that the HSE is continuing to work with the Mount Carmel Hospital group to ensure a seamless transfer of patients to alternative hospitals. We would endeavour to support staff in their efforts to find alternative employment. In that regard, I am pleased to note that some of the staff have already been offered employment and other hospitals.

There has been much commentary on the closure of Mount Carmel Hospital. It holds a special place in the hearts of many people, particularly those who have had their babies there. They are understandably sad that the hospital is closed. However, in considering the option to purchase the hospital, I had to make an evidence-based decision. The position is that the acquisition of Mount Carmel as a stand-alone, low-volume maternity hospital would not be in line with current policy on safe and high-quality maternity services. In view of falling birth rates, there is no evidence of a need to acquire additional service capacity. Buying the hospital as a going concern would, therefore, have unnecessarily exposed the HSE and the State to very obvious and significant financial risks. I am satisfied that we have taken the right decision and that we have done so for the right reasons. However, I must express again my concern for those who have worked in the hospital over the years and who provided such great service. We will do all we can to ensure that we find a place for them in our health services elsewhere. I am assured by Mr. Carter that, in respect of the former patients, including those who were in the hospital until recently, we have managed a seamless transfer in almost all instances. That work continues.