Seán Sherlock (Cork East, Labour)

I wish to raise an issue which I feel will have a deep impact on the ability of hospitals like Mallow General Hospital to deliver acute services.

For the past five years we have been through a number of processes in relation to Mallow General Hospital, including the Horwath, Wrixon and Teamwork reviews. Now, through a new national reconfiguration process, the HSE will seek, in an underhand and surreptitious way, to undermine the ability of the hospital to deliver acute services.

I have before me a document in respect of this matter. The people who represent the interests of the hospital and who live within its catchment area are undergoing a reconfiguration process, headed up by Professor John Higgins. There is general agreement that change is needed within the hospital and that there will be implications for the delivery of acute services, but that the capacity of the hospital should not be undermined in any way. In other words, if there is to be a loss or diminution of acute surgical services, they would be buttressed by acute medical services.

We have bought into that process and have been given assurances in relation to it. We now discover documentation emanating from the HSE showing that it seeks to assign to every hospital in the country a new modelling system ranging from 1 to 4, depending on the category of hospital, and which will put Mallow into the No. 2 category. The document states that this hospital will not have an ICU so the patients and doctors need to be made aware that the resources are not in place to provide the full spectrum of an acute hospital resuscitation, that is, intubation, ventilation and resuscitation, IVR. The patient must give informed consent and have knowledge of this prior to admission. A ceiling of care discussion needs to take place and be documented with appropriate patients prior to admission to this facility. The document goes on to say that standards of care should be measured and comparable to those delivered at a model 3 and model 4 hospital. A model 3 or 4 hospital would be the equivalent of Cork University Hospital, which is a tertiary centre and the nearest geographically to Mallow.

I demand a meeting with Mr. Pat Healy, regional director of operations for the HSE south region. I demand respectfully, as is my right as an Oireachtas Member, a meeting with Ms Laverne McGuinness and Mr. Brian Gilroy, who are in charge of efficiencies, and I demand that the Joint Committee on Health and Children discuss this document because it will have serious implications for the delivery of acute care. By a surreptitious and secretive method, the HSE will seek to diminish the ability of Mallow to deliver acute care. If a ceiling of care discussion has to take place on every admission, most people will not be admitted to the hospital and will have to go to CUH, thereby reducing the ability of Mallow General Hospital to deliver services.

There are many scenarios where resuscitation might be appropriate for an individual on whom a "do not resuscitate" order has been placed, for example, anaphylactic reaction to an infusion. Such a notion has major consequences for the status and reputation of a hospital and for the esteem of those working there. Discussion about ceilings of care as espoused in this process is, in most clinical situations, unnecessary and often inappropriate and counter-productive. I wonder if dividing patients into categories of access with regard to resuscitation is unconstitutional, in that it would negate the rights of a patient.

Numbers in the hospital would be so reduced that it would not be viable. That is what is at play here. This is an attempt by the HSE at national level to undermine the local reconfiguration process which all of the stakeholders have bought into. We recognise that change is needed but it seems the HSE is trying push through a plan whereby hospitals like Mallow will no longer be able to provide acute care, whether medical or surgical, and the 4,500 people who are served in an acute setting in Mallow will have make their way through CUH, which does not have the capacity to deliver those services because the capital investment has not been made there.

We need transparency. I am asking, as is my right as an Oireachtas Member representing the people of Cork East, for a meeting with the HSE at national level so that I can learn what plans are afoot and what surreptitious methods are being employed in the downgrading of hospitals like Mallow.

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