Oireachtas Joint and Select Committees

Thursday, 17 December 2015

Joint Oireachtas Committee on Health and Children

Acute Hospital Services: Discussion

11:15 am

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome Mr. Michael O'Flynn, Professor John Higgins, and Mr. Gerry O'Dwyer and extend my best wishes to them for the festive season. I thank them for their work on this issue.

The report was detailed in its content. Was it based on the Horwath and Teamwork review of acute services in HSE South? The delivery of acute hospital services in the south and the hospital groupings do not exactly mirror each other because we have an expansion of that hospital grouping to include Waterford and south Tipperary. This means it is a larger geographical and population area. Are there any issues that have to be addressed in the overall reconfiguration of acute hospital services? Will that change any of the strategies or long-term planning and vision in the general region or is it just an administrative and management issue? Does further research have to be done on this? South Clonmel has had 1,200 to 1,300 births every year, for example. There is a move to bring ophthalmology and other services from Waterford to Cork. Will services be sustainable? All of these will place further additional pressure on the tertiary hospital in Cork if we do not have a strategic plan to develop a second tertiary academic hospital there.

We often discuss acute hospital services in isolation. I accept this report has not done that. For too long, however, we have been obsessed with the acute hospital being the provider of all services. When we are looking at developing strategies across the health service, we need to take account of GP services, community services, primary care centres, urgent care centres and acute hospitals. In the overall report, does Mr. O’Flynn see a need for us to look holistically at the further development of policies and initiatives which provide health care across our communities? Should it be a case that we are not looking at primary care centres based on one set of criteria which are not complimentary to the broader acute hospital service itself? Many people attending our acute hospital services, particularly our emergency departments, should not be there in the first place. That has been statistically proven time and time again. If we had a stronger primary care network with more diagnostic availability for GPs and more decentralised, then we have more capacity for elective care.

On the issue of academic research and innovation linking UCC and the teaching hospitals, Mr O'Flynn stated a memorandum of understanding would be required. Is there something similar in place already?

The reconfiguration of services often happens not because of strategic long-term planning but for the need to contain budgets. It is dressed up as reconfiguration.

This has happened time and again across the State: a tightening budget, capital plans shelved and current expenditure rolled in so services are reconfigured. The theory behind reconfiguration is to centralise in centres of excellence and farm out the least complex surgery and treatments to primary care and the peripheral hospitals but traditionally that does not happen. Instead, there is centralisation but less complex treatments are not transferred. Is there any acknowledgement in this report of the need when reconfiguring to take a twin-track approach rather than centralisation? This is not a political point but an observation that is widely acknowledged.

When people see reconfiguration and concentration of services the elective issue is not the major concern but emergency services cause huge concern. People will travel a distance for elective care, surgery and diagnostics. Did the witnesses consider the ambulance and emergency services for the whole region when proposing the reconfiguration?

Every politician will be promising to have one of these services in his or her townland between now and February. When the witnesses talk about a modular hospital and space, I assume they mean physical space in terms of acres or square metres for sites, and by public transport they mean trains, buses and proper motorway structures. Have they also considered the additional, eastern part of this new hospital group in terms of proposing a hospital site? It does not have to be in the east of the city but there will be extra capacity required in the long term because the hospital groupings will take in an additional 200,000 people. Has that been taken into account or is there scope to amend this to allow for that to happen?

I thank the witnesses for their efforts. Public service, professional and voluntary is often not appreciated but should be acknowledged.

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