Alan Kelly (Tipperary, Labour) | Oireachtas source

I welcome the delegates, particularly my two local HSE representatives.

We have talked these issues to death in the Chambers. It has been ongoing for decades and the blame game goes on all of the time. I have read the Department's statement, but what is the plan? The HSE does not act in a silo. We need to refocus some of our attention onto the Department. We now know about issues with the budget for this year. What are the plans in that regard? It will have an impact on our discussion. When is the Department cutting things off or is it just going to run on? The answer could decide whether we are to have a general election. I am not joking when I say that. There is a significant budget overspend. How is the Department going to manage it, given the topic we are discussing? Let us not have a generic, rubbish answer. The officials are obviously planning for it. I have been in Departments long enough myself. What are they going to do this year that will be different from they did every other year? Are they going to do something different? They should tell us now in order that we can prepare for it.

Does the Department think the recent and forthcoming changes to structures in the HSE are having and will have any impact on service provision? I would appreciate it if Mr. Bolger answered that question. There is a lot of change. A new board is being appointed before a chief executive, something I suggested to the Minister and in fairness he took up my suggestion. It looks like there will be the reintroduction of regional structures, which is necessary. There are new positions being advertised, as well as lots of stuff going on. Is all of this change having an impact and, if so, is the impact negative?

My final question is about a budgetary issue from a departmental vision point of view. When I look at eldercare services in particular, I have a real issue. It is a real bugbear of mine that from a financial and a service provision point of view, there are escalating costs associated with home care as compared to helping people in nursing homes and also with people spending a night in an acute care setting. The vision is not working to deal with people in the first tier and possibly the second and to provide a third. This would reduce the problems of some of those working in the HSE because it would reduce the volume of people who end up in hospital and acute care settings. That question is also for Mr. Bolger.

My other questions are for Mr. Woods, in particular. I live in County Tipperary. The two biggest issues for waiting lists and accident and emergency departments are South Tipperary General Hospital and Limerick Regional Hospital. They are on either side so we are getting it both ways. It is a real issue. Maybe Ms Cowan could outline to the committee how we got a fabulous new accident and emergency department which myself and the Chair visited. It is three times the size of the old accident and emergency department yet the volume of people attending it increased dramatically over its capacity. I presume there was research done into why that was the case. If it was not at that scale in the beginning there are obviously underlying issues.

On the pathways for the groups of hospitals across the country, I will use my own mid-west region as an example. We have Limerick, Nenagh and Ennis. I congratulate them on what they did on cataracts. It is a great example and should be done around the country. The centre is going to be in Nenagh. The issue for me is that the pathways by which patients are being managed in the groups of hospitals across the country needs to change. More people need to be moved out of the model 1 hospitals out to model 2 and 3 hospitals quicker for aftercare and pre-care and there are real issues in how that is happening. There was only one ambulance in Thurles at the weekend, where there were 50,000 people. Intermediate care vehicles are something I have been talking about for years; it is a bit of a joke really. A small bit of investment there would move people pretty quickly. We would not have the same level of issues in Limerick if we had people moved out to Nenagh and Ennis quicker. Why is that not happening?

This is a rapid fire round. Have there been any changes to how the HSE manages relations with GPs? Are lists kept in respect of GP referrals to accident and emergency departments? Maybe not for public consumption but at least for the HSE, are heat maps done of GP referrals to accident and emergency departments? What are we doing to ensure that hospitals are run seven days a week instead of five days a week in respect of consultants and work? Can Mr. Woods update me on the history, decision making and current deployment of modular units across the country? This was decided some time ago. There is a proposition from Limerick to put in a modular unit. Will that be supported? Will Mr. Woods answer me here and now? Modular units are proposed for other parts of the country. When was that first mooted in the HSE, what are the locations and have decisions been made on them?

I have specific issues in respect of paediatrics. This is a public matter so there is no issue about naming him. Two weeks ago, a 14 year old boy called Matthew Quinn, who I went and met, was on the Six One news about waiting lists. He has Down's syndrome and is waiting for a hip replacement for two years. He slipped and needs an operation. For two years he has been flipped between Crumlin and Tallaght. I have read there are issues in the relationships between the two hospitals and in respect of paediatric services. Meanwhile, a 14 year old boy with Down' syndrome who was asking me to help him get a new leg is waiting for an operation. What is going on there? This is only one case.

This is the real kicker. Recently there was a lot of media coverage in respect of the hospital network in the mid-west.

By comparative standards, looking at the staffing ratios in the mid-west versus other parts of the country - and this was in the media for some time - there are 14% less staff in the acute services. How did this happen? Why was it allowed to happen? Why was the mid-west not supported? Will this be addressed? Five hundred and sixty staff correlates to the highest mortality rate in Ireland. Did anyone in the HSE know this? The cost for those staff - doctors, nurses, specialists - is €22 million. When will this be addressed? Why is the mid-west's employment levels, according to these figures, which I have not seen challenged - and if they must be challenged, they should have been challenged by now - that much below the employment levels of all other acute services across the country? The Chairman knows what I am talking about.