Dáil debates

Thursday, 9 July 2009

12:00 pm

Photo of Áine BradyÁine Brady (Kildare North, Fianna Fail)

An upgraded scanner will require less infrastructural works, will incur lower service charges, will include a free parts replacement guarantee and will allow advantage to be taken of a trade-in discount on the existing scanner. The HSE is extremely mindful of the relatively low volumes of scans likely to be a feature of this service and will tailor both the service configuration and the clinical governance arrangements accordingly to ensure that any issues related to expected volumes are appropriately managed. As a minimum, this will involve the CT service at Monaghan hospital operating within an overall single radiology department for Cavan and Monaghan hospitals, with appropriate rotation of radiography CT staff between the main CT service at Cavan hospital and the Monaghan hospital site to ensure skill levels and clinical competencies are maintained. It is anticipated that this service will operate within existing staffing levels and should be operational by late September or early October.

I wish to assure the House that there will continue to be a significant role for each of the acute hospitals in the region. Rather than operating largely independently of each other as at present, they will come together to enable the provision of a comprehensive integrated service. We need to recognise that the way in which hospital services are provided is changing rapidly and a growing proportion of care can be provided on a day basis without the need for overnight stays. I appreciate that people are concerned about services to deal with those who fall seriously ill or who are involved in an accident in areas further away from Cavan hospital. Pre-hospital care is the key to quality emergency and trauma management, regardless of hospital configuration. There always will be people who live considerable distances from any hospital and the key is to ensure that pre-hospital services are put in place that enable life-saving treatment to be provided quickly to such patients.

Medical evidence demonstrates that stabilising a patient should commence as rapidly as possible for someone who has suffered significant trauma. In the case of a road accident, this should happen at the roadside and be carried out by advanced paramedics. All the evidence demonstrates that people with severe injuries are best dealt with in large hospitals with a range of specialist teams to deal with serious injuries to different parts of the body. Ambulance services for Monaghan and Cavan already have been enhanced to include an additional emergency ambulance. This is in addition to two existing emergency ambulances based at Monaghan ambulance station. An intermediate care vehicle will also be based there for the transportation of non-emergency patients between hospitals. Advanced paramedics have also been deployed in a rapid response vehicle on a 24-hour, seven day a week basis to provide the population of Monaghan with access at the scene to life-saving treatments including blood and anti-clot treatment.

Ten posts were identified to deliver a significantly increased number of care packages in the community. Nine staff are in place at present, with the tenth person expected to be put in place shortly. These care packages will support the Cavan and Monaghan hospitals, further relieving the pressures on acute hospital services in the area. The HSE is managing the change process in Cavan and Monaghan through a network of subgroups. The HSE has stressed the importance of the involvement of all relevant stakeholders in this process and the HSE has sought the participation of general practitioners on a number of the subgroups particularly in respect of the development of the medical assessment unit in Cavan.

The sub-groups are being supported by specialist risk advisers to ensure that the change process is managed smoothly and, in particular, with a view to ensuring that any associated risks or challenges are identified and addressed in advance of any service changes. The HSE has reiterated that it has and will continue to seek engagement with GPs on this issue. Last week, the HSE held two sessions with GPs and work will continue to help ensure the GPs involvement, which is required for a well-integrated service linking hospitals and the community.

The HSE is due to issue an information leaflet to all households in Monaghan shortly to advise them of the minor injury unit. Advertisements are due to be placed in local newspapers in Cavan and Monaghan next week to remind the public of the new arrangements. The emergency unit consultants wrote to GPs in Cavan-Monaghan, on behalf of the HSE, on 7 July 2009 to outline the referral process and the inclusion and exclusion criteria to them for the proposed minor injury unit at Monaghan Hospital.

It is frequently alleged that the Government and the HSE want to downgrade smaller hospitals, principally to save money. This is not so. There is an abundance of expert medical advice that small hospitals with low patient volumes should not continue to provide complex care.

Comments

Peter McMahon
Posted on 30 Jul 2009 9:04 pm (Report this comment)

The glossy publication from the HSE, advising the public as to the type of injury which would be treated in Monaghan and those which would require the patient/victim to go instead to Cavan/Drogheda/Dundalk or Navan has caused absolute confusion and derision. Just to give you a flavour - you can go to Monaghan with a nose injury but not with a facial injury. This means that those who do not keep the nose on the face will be sure of treatment. They will treat cuts and grazes in Monaghan but not if those are received from a fall from any height.
This all seems to be an attempt to mislead and confuse the public so that they will not go near Monaghan. This is now happening as people can treat those injuries at home or by going to the local pharmacy. This suits the HSE who will, in the near future, announce that the Minor Injuries Unit is unsustainable and must close completely, which is what they have wanted all along.

Peter McMahon
Posted on 30 Jul 2009 9:12 pm (Report this comment)

The medical evidence re. stabilising a trauma victim as soon as possible refers to stabilisation in a hospital setting and not by paramedics along the roadside. Research has shown that your chances of survival in a trauma situation are much better when attended by an EMT as opposed to an Advanced Paramedic. The AP remains at the site carrying out all the procedures he/she has been taught and this delay can be fatal.
There is no evidence to show that we are going to have a better service or that we can be kept alive until we reach a distant hospital or that we will get a better service when we arrive there. For these reasons we reject the new configuration of services and will hold certain people responsible when the fatalities happen.

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