Dáil debates

Wednesday, 27 September 2006

2:30 pm

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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Question 110: To ask the Minister for Health and Children her views on the report into the death of PJ Walsh in Monaghan Hospital; and if she will make a statement on the matter. [29758/06]

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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At the outset, I wish to convey again my sincere sympathy to the Walsh family on the death of Mr. Patrick J. Walsh. Following his death in Monaghan General Hospital on 14 October 2005, the Health Service Executive commissioned Mr. Declan Carey, a consultant surgeon at Belfast City Hospital and an honorary senior lecturer at Queen's University, and Professor John Monson, professor of surgery University of Hull, to carry out an independent and external review.

The HSE published the report of the independent inquiry on 7 September. The report details the difficulties that arose in trying to secure Mr. Walsh's transfer from Monaghan to either Our Lady of Lourdes Hospital, Drogheda or Cavan General Hospital. It also exposes a failure in communications between clinicians and hospitals in the region.

The reviewers considered that making the changes would definitively remove the risk of similar clinical incidents occurring again in the region. Since the death of Mr. Walsh, a new protocol for patient transfer has been put in place. It provides that all requests for transfer from Monaghan General Hospital to Cavan General Hospital or Our Lady of Lourdes Hospital, Drogheda should be granted and processed immediately. The HSE recently established a steering group and a north-east project group to oversee a programme to improve safety and standards across the acute hospital network in the region.

The Teamwork report makes a number of short, medium and long-term recommendations. It concludes that the present system, where five local hospitals deliver acute care to a relatively small population, is exposing patients to increased risks and creating additional professional risks for staff. The report highlights the need to develop a high quality and responsive emergency and planned service, in line with international standards, by developing local services within existing hospitals and other local centres supported by a new regional hospital.

Led by the HSE's National Hospitals Office, a steering group has representation from key stakeholders such as clinicians and primary care providers. The project group is being led by a consultant surgeon from outside the region, Dr. Eilis McGovern. The HSE has given me an assurance that, in progressing the implementation of these reports, there will be no discontinuation of existing services until suitable alternative arrangements have been put in place.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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The events leading up to the death of Mr. Walsh were tragic, but what is emerging from the report into his death is equally damning of the Government. The report states that the events that led to Mr. Walsh's death still occur daily in the Monaghan Hospital region. The report also states that the consistent theme that emerged was that neither Cavan Hospital nor Our Lady of Lourdes Hospital has sufficient capacity to deal with current patient demands.

On the basis of those findings, I would like the Minister to answer a number of questions. As matters stand, who is responsible for highlighting new or existing protocols? A failure in making known to people the existing protocols contributed to Mr. Walsh's death. Does the Minister know who is responsible for making new or existing protocols known to all staff working in all these hospitals in the area?

Does the Minister know if all the acute hospitals in the country have a programme of clinical governance and who is responsible for clinical governance? Is Professor Drumm ultimately responsible for making sure every hospital has a programme of clinical governance in place to ensure that such an incident will not occur in another hospital? It is important for the Minister to explain to the House whether such a programme is ongoing.

I have two further concerns. On the basis of the Teamwork report, Our Lady of Lourdes Hospital is expected to take all critically ill patients from the north east, but it has received no additional funding to care for these additional very sick patients. It is fine for the Minister to say what she said in her reply and we all fully sympathise with the family of Mr. Walsh, but as a member of the Government, the Minister is doing nothing to stop a similar incident occurring, unless she ensures that additional funding is made available to Our Lady of Lourdes Hospital.

Another matter of concern that reached my attention is that the proposed extension of Our Lady of Lourdes Hospital under the capital building programme has been suspended.

Séamus Pattison (Carlow-Kilkenny, Labour)
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The Deputy should confine himself to asking questions and not make statements.

3:00 pm

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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I ask the Minister if that is true. Is she aware the capital building project for Our Lady of Lourdes Hospital has been put on hold? Talking about a new hospital for the north east is along the lines of building castles in the sky, when there are currently huge deficiencies in services in the north east. Talking about doing something for them in 15 years' time is absolute nonsense, when there are problems now in Our Lady of Lourdes Hospital and Cavan General Hospital.

I will put a very important question to the Minister. I do not know if she is aware that Cavan General Hospital is subject to an absolute obligation to receive surgical transfers from Monaghan General Hospital. A problem which arose in the case of the death of Mr. Walsh was that nobody took responsibility for his transfer. If Cavan General Hospital is told it must now take every single patient from Monaghan, does the Minister know if restrictions still apply to surgeons in Cavan which preclude them from carrying out major GI surgery? There is no point in a patient having an absolute right to be transferred from Monaghan to Cavan when, upon arrival, he or she will not be operated on and no intensive care services will be available for them. That is the reality on the ground and those are the key questions I would like the Minister to answer.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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A new protocol for patient transfer has been put in place. It is the responsibility of the HSE to oversee what happens in the different hospitals in the region. We already know that approximately half of the patients in the region attend not local hospitals but hospitals in Dublin. That is the largest ratio of all the regions in the country for people attending Dublin hospitals rather than those in their own region.

Photo of Damien EnglishDamien English (Meath, Fine Gael)
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They have no choice.

Photo of Seymour CrawfordSeymour Crawford (Cavan-Monaghan, Fine Gael)
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Then close them.

Photo of Damien EnglishDamien English (Meath, Fine Gael)
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They have no choice, tell the truth.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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Cavan General Hospital has the same number of beds as Mullingar General Hospital. When comparing inpatient activity, day care or accident and emergency activity, there is a huge difference between what is done in Cavan and what is done in Mullingar, and I have said so on the public record on a number of occasions. The authorities in Cavan have visited Mullingar and I welcome that. It is good that hospitals work with each other to improve performance.

The report was produced by clinicians, not politicians, administrators or bureaucrats. Clinicians made the recommendations therein. One of the most worrying aspects of the report was that attention was drawn to a situation in the region where interpersonal relationships among clinicians interfere with patient care.

Photo of Seymour CrawfordSeymour Crawford (Cavan-Monaghan, Fine Gael)
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That is not new. We did not need a report for that.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I only refer to what is in the report. I am not inventing it. It is a huge concern to me as Minister for Health and Children.

Photo of Seymour CrawfordSeymour Crawford (Cavan-Monaghan, Fine Gael)
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It has been known for years.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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It is of huge concern if interpersonal relationships interfere with patient safety and care. That is why, as a matter of priority, the HSE has appointed a group, headed by Dr. Eilis McGovern, who is a well-known heart surgeon and well-respected clinician, to oversee the implementation of the recommendations for the region. Clearly there will be difficulties implementing the recommendations because change is never easy but we will ensure that what happens at each hospital is founded on patient safety. Whatever can safely be done in a particular hospital will continue to be done.

There are issues around clinical governance nationally but normally it is the responsibility of the medical board of a hospital. In the context of a new contract of employment we want to move to the clinical directorate model, currently operating very successfully in St James's Hospital in Dublin and representing best practice norms around the world. On foot of the Harding-Clark report the Department of Health and Children has done some work on these issues. There are still huge deficiencies in what happens on the ground and legislation may be necessary for the future.

Séamus Pattison (Carlow-Kilkenny, Labour)
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We must move on to Question No. 111.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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Very little of what I asked was answered by the Minister.

Séamus Pattison (Carlow-Kilkenny, Labour)
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I ask the Deputy to be brief.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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The question related to matters over which the Minister has control, namely, the current day-to-day spending increase for Our Lady of Lourdes Hospital, which is to look after critically ill patients, and whether the capital project for Our Lady of Lourdes Hospital has been stopped. When the Minister said there were problems in Cavan and Mullingar did she, on seeing such glaring problems, make herself aware as to the reason for them? What are those problems? I have an idea why they exist but if I were Minister for Health and Children, I would try to do something about them rather than just highlight them as though I were a disinterested party. If she knows what the problems are between those two hospitals, she should inform the House why they exist and explain the difference between Cavan and Mullingar so that we can do something about it, not just point out that there is a difference.

One of the problems with Cavan General Hospital is that the surgeons are restricted in the work they can do. There is no point sending seriously ill people to Cavan General Hospital if the surgeons there cannot operate on them. Having a protocol insisting that every surgical patient from Monaghan goes to Cavan is nonsensical. It does not take a medical professional, administrator or bureaucrat to work that out. It is daft.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I have substantially increased the capital funding available to the Health Service Executive this year. Once I approve a capital programme, I do not try to find out how it is spent every week. In light of the Teamwork report and given the decision made and endorsed by the Government that we will have a new, state-of-the-art hospital for the region, any decisions made about spending on capital projects or otherwise should fit in with that overall approach. The region merits and has long deserved a state-of-the-art hospital. In particular, the urgent developments that need to take place in Monaghan, Cavan, Drogheda and Navan will happen and the HSE will ensure they do so quickly. Professor Brendan Drumm and his team are committed to making that happen quickly.

When we examine budgets and bed numbers in Mullingar and Cavan hospitals, the outputs are different. This may be because of some of the issues raised by Deputy Twomey. However, throughout the country we see wide variations and the purpose of reform is to try to have every hospital performing to the highest level of efficiency and effectiveness. Mr. John O'Brien and his team at the National Hospitals Office are working hospital by hospital to try to bring that about. The more hospitals learn from each other and work together, the sooner we will achieve that target.