Dáil debates

Thursday, 16 November 2006

4:00 pm

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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I thank the Ceann Comhairle for his courtesy in this matter. It is important that backbenchers get the opportunity to raise these issues. I will talk about Dublin South-West, and I invite Deputy Gormley to come to Tallaght with the Green Party candidate and I will be happy to show her around.

In Dublin South-West we do not just talk about Tallaght, we also talk about Firhouse, Templeogue, Greenhills, Brittas and Bohernabreena. It is important to recognise the huge population in that area and that the Department and the Minister take account of the need for the further development of hospital and community health services in the area. There has been much progress in recent times, with positive developments under successive health boards on community facilities. We have a tremendous health centre in Jobstown and GP centres in Killinarden and Brookfield. The Millbrook Lawns health centre, however, still needs to be redeveloped after it was damaged by a fire seven years ago. I have continued to badger the HSE on the need to start work now on that project.

No discussion on the future of hospital and community services in south-west Dublin could ignore the situation in Tallaght Hospital. I acknowledge the interest the Minister of State, Deputy Brian Lenihan, has shown in this subject. The Ceann Comhairle was one of the Fianna Fáil Ministers for Health who drove that project and who was kind enough to appoint me to the board in 1988. I took a particular interest in the campaign and I was involved in AMANCH board set up in 1988 to move the Adelaide, Meath and National Children's Hospital to Tallaght. The National Children's Hospital is the focus of a lot of attention throughout the Dublin region, particularly in the Tallaght area.

We need information. The HSE has reached a decision and there has been much talk about the process it went through and the surprise throughout Dublin, particularly in Tallaght, about Tallaght Hospital not figuring in the final decision. It maintains that all nine criteria were fulfilled and there is scepticism about the decision even among medical professionals.

We must now move on. As someone who has been involved in the project and who lives within the shadow of Tallaght Hospital, we must be told by the Department and the HSE what is happening. The future for the delivery of children's hospital services in the Tallaght region must be spelled out. We do not know what is going on and there have been protests and community activism as a result. This is the third largest population centre in the country so people need to know what is happening. There is a huge youth population in Tallaght, with many young families and we must be clear following the decision on the Mater Hospital site about what will happen to children's services in Tallaght Hospital.

My position is clear, children's services must be retained in Tallaght. In fact further development is also an issue. I hope the Minister of State will give us some insight in that regard. I am happy to join with my colleague, Deputy Crowe, in raising this matter which is a very important one for my community and me personally. I feel very strongly about my local hospital. Not only am I a local representative, I am a campaigner for the services in that area. I have been a patient in the hospital, and it is important that the Department understands that people in Tallaght need to know the answer. I thank the Ceann Comhairle for facilitating both Deputy Crowe and myself. I look forward to the Minister's positive reply.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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I wish to reiterate what my colleague has stated about the uncertainty existing in Tallaght at the moment. I have lived in Tallaght for the past 18 years and I worked on the ground prior to that. I have seen Ministers come and go on the Tallaght Hospital issue. I do not know how many sod turnings we saw, with different Ministers coming from different Governments. We eventually had the hospital opened, from which day it has been dogged by controversy.

This is the latest fear and scare for the local people. A month ago, between 3,500 and 4,000 people marched on the streets of Tallaght.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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Including us.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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They were trying to draw attention to the problem which exists. They are afraid and frightened not only for themselves, but for their children and the communities they represent. We have had different messages coming from Government. One Deputy has stated there is no threat to services, but another Deputy is unsure.

What will happen to the National Children's Hospital in Tallaght? Last year, 67,221 patients went through the National Children's Hospital, such is its scale. We can discuss the movement to the Mater Hospital. I surveyed the time it takes to go to the Mater Hospital from Tallaght Hospital. It took me an hour and a half to get there. A colleague, one of our local councillors, managed to get there in less than an hour by car but not in peak-time traffic.

If between 3,500 and 4,000 people marched on the streets on a Saturday, this must be motivating people. Tallaght is one of the most densely populated areas on the island, and it has the most rapidly growing population. It has the largest proportion of people of child-bearing age and young people. Yet we have the real prospect of losing a vital paediatric service from the area. It is being conveniently moved to the Taoiseach's constituency, but that is a discussion for another day.

We are interested in what is in the best interests of children in the area we represent. That is what the issue is about. We are more interested in seeing a positive conclusion to this, and we want to know what will be the future of the hospital. Will the Minister provide that answer? It does not appear possible to give the answer through parliamentary questions or otherwise. In that vacuum, people's fears are growing. The experiment of travelling from Tallaght to the Mater Hospital highlighted a number of issues including the traffic problem. It also highlights a danger for families with extremely sick children. A number of people I know have had children with meningitis, for example, and the hospital being on their doorstep saved the children's lives.

This will certainly be an election issue, although we are not looking for an answer because of that. We need those answers for the people living in that area to cut across all the uncertainty and worry that is out there, particularly for families. At a public meeting, a member of the board told people the hospital was closed, and if a child gets a sore throat, he or she would have to got the Mater Hospital. I do not know if that is the case, but we are entitled to answers.

Instead of the population decreasing as it is in other parts of the city, Tallaght's population is expanding. The other worry with regard to south-side services relates to the facilities in Crumlin. Consultants there have stated they were not consulted on this closure. There is a worry of whether there is enough space in the Mater Hospital and if there will be services for families to stay overnight and so on.

As anyone in Dublin knows, it is easier to get out of the city centre than it is to get in. If a person has a sick child on the outskirts of the city, the worry is how to get into the city centre. If a person does not have access to a helicopter or a private car, that person relies on public transport. We know how clogged up the roads are.

Photo of Brian Lenihan JnrBrian Lenihan Jnr (Minister of State, Department of Education and Science; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Health and Children; Dublin West, Fianna Fail)
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I thank Deputies O'Connor and Crowe for raising this matter on the Adjournment. I am making this reply on behalf of my colleague, the Minister for Health and Children, Deputy Harney. The Minister is aware of the specific concerns which have been expressed regarding the future development of services at Tallaght Hospital, which operates within the catchment area of Dublin South-West. These concerns have largely centred on the position with regard to the provision of paediatric hospital services at Tallaght.

Following the Government decision on the location of the new national paediatric hospital, the Taoiseach, the Minister and the chief executive officer of the HSE met with representatives of Tallaght Hospital, including Archbishop Eames, to discuss the implications of the decision for the National Children's Hospital at Tallaght. A number of matters relating to the provision of adult services at Tallaght were also discussed. Development proposals submitted by the delegation in this regard have been forwarded to the HSE for consideration.

In a letter to the Archbishop following the meeting, the Taoiseach gave an assurance that the Government wishes to see Tallaght Hospital thrive on a sustainable basis as a particular focal point for the involvement of the minority tradition in the health care system and as a key health provider to an expanding local population. These objectives will be pursued in tandem with other compelling objectives, including the achievement of an effective and efficient hospital care system, which will deliver the highest possible standards of care within a framework designed to respond to the needs of patients at national, regional and local level.

A joint HSE and Department of Health and Children transition group has been established to advance the development of the national tertiary paediatric hospital. Among the key items to be addressed are the definition of a high level framework brief for the new hospital and the determination of the range of services and location of the associated urgent care centres.

We are trying to do the best for all our children, both in Tallaght and Dublin as a whole. The current arrangements for the provision of hospital services for children in the Dublin and national area are not satisfactory. On a sustainable basis, there is only room for one national tertiary hospital centre in this country. Deputies have obligations to patient safety, and they have an obligation to advise the public about dangers to patient safety when such exist.

What is being attempted by the HSE, through a transparent process, is the establishment of a location for the national tertiary hospital for paediatric services. All the hospitals in the Dublin area, including Tallaght Hospital, participated in that process. Their participation in that process indicated a willingness to be bound by a decision. A decision was arrived at, which had to happen. There was not room for two or three paediatric tertiary hospitals in Dublin, as that is the unsatisfactory arrangement we have currently. That is the issue that required to be addressed.

However, the group will have consultations with relevant stakeholders, which will include representatives of the National Children's Hospital at Tallaght. I would like to salute the work done at that hospital, and the staff who work there.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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Hear, hear.

5:00 pm

Photo of Brian Lenihan JnrBrian Lenihan Jnr (Minister of State, Department of Education and Science; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Health and Children; Dublin West, Fianna Fail)
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There are clearly relevant stakeholders who will be consulted on the whole issue of the determination of the range of services, and the location of the associated urgent care centres.

To date, no decision has been taken on the range of services to be provided at the National Children's Hospital at Tallaght in the context of the development of the national paediatric hospital and the associated urgent care centres. I understand the transition group is currently in the process of contracting external assistance on the preparation of the high level framework brief for the new hospital, which will include recommendations on the number and functional content of the urgent care centres required to support the new hospital. The strategy, Primary Care: A New Direction, aims to develop services in the community to give people direct access to integrated multidisciplinary teams of general practitioners, nurses, health care assistants, home helps, occupational therapists and others.

It has been estimated that up to 95% of people's health and social services needs can be properly met within a primary care setting and the establishment of the new primary care teams can contribute greatly to enhancing community-based health services in these areas.

The HSE received additional revenue funding of €16 million in 2006 to support further implementation of the strategy. This represents a significant increase over previous years and brings the total ongoing funding to €28 million per annum.

Out of the €16 million provided, €10 million has been earmarked to establish up to 100 primary care teams, composed of 300 additional front line professionals. Altogether, this will ensure integrated, accessible services for the populations served by these teams. The funding is being targeted by the HSE to provide the potential for each local health office, formerly community care areas, to establish up to three primary care teams. The HSE is currently in the process of finalising arrangements for the establishment of the primary care teams in 2006. Further funding of €10 million is being provided in 2007 to enable the full year cost of these developments to be met.

Out-of-hours co-operatives allow general practitioners to put in place arrangements to provide services to their patients while their surgeries are closed in the evenings, on weekends and bank holidays. The development of GP co-operatives is in line with the overall health service policy of strengthening primary care services and ensuring that to the greatest extent possible, the needs are met in the primary care setting.

Co-operative arrangements involving approximately 250 general practitioners are already in place, serving a substantial proportion of the population on the south side of Dublin. I understand that work is under way on the development of a specific GP out-of-hours service for the Tallaght and Clondalkin areas. The HSE will also consider what other developments may be required to ensure people living across south Dublin have access to appropriate GP out-of-hours services, seven days a week.

I appreciate that both Deputies are most anxious to raise the question of the future of what is colloquially described as Tallaght Hospital. I know this because Deputy O'Connor has raised this question with me on numerous occasions and Deputy Crowe raised the question in the House this evening. I focused in my reply on the obligation of Deputies in respect of matters of patient safety. I should have been more precise and refined. I am actually talking about patient outcomes, not patient safety. Safety and the treatment of patients in Tallaght are of a very high standard but there is a question about how we achieve the best outcomes for our children in terms of the configuration of the hospital system in Dublin. This was the subject of the report. It is clear from the reply I have made on behalf of the Minister that she is willing to engage with all relevant stakeholders including the National Children's Hospital at Tallaght in that context.

Photo of Pat BreenPat Breen (Clare, Fine Gael)
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I am concerned about the recent announcement made by the HSE and the Minister for Health and Children, regarding the provision of a six-slice CT scanner for Ennis General Hospital. The widely-held view among medical practitioners is that the imaging quality of such a CT scanner is inadequate as a modern diagnostic tool. The Department of Health and Children should immediately instruct the HSE to purchase a higher grade CT scanner.

I recently called on Clare voters to be extra vigilant over Government assurances on the county's health services in the run-up to the election and there is nothing about this latest announcement on the CT scanner that makes me change my mind.

I have spoken to consultants on this matter and they have assured me that anything less than a 16-slice scanner is yesterday's technology being applied to tomorrow's health services. The population of Ennis and County Clare is growing and is currently more than 106,000. The first prototype 16-slice scanner was apparently introduced in 2001 and 64-slice scanners are now common. In proposing a six-slice scanner for Ennis General Hospital the Minister is seeking to install pre-2001 technology. This does not seem like very old technology but this is one area that is subject to rapid technological developments.

Since I tabled this motion I have been made aware that there is a doubt about whether there is such a thing as a six-slice scanner and that, in effect, the Minister is sanctioning a fictitious piece of equipment for Ennis General Hospital.

I remind the House of her reply to me last week. After much toing and froing between my office and her Department over whether she would approve the revenue costs to operate a CT scanner in Ennis — an answer to which I am still awaiting — she stated:

the Hospital has been given approval by the HSE to purchase a six-slice CT scanner. The HSE is currently considering the revenue requirement for the new scanner.

The HSE informed me on 12 October that they were awaiting funding to proceed. I ask the Minister of State the reason Ennis should be given a six-slice scanner when Ballinasloe's Portiuncula Hospital is getting a 64-slice scanner and Nenagh General Hospital a 16-slice scanner. Why is something inferior marked down for Ennis? Why is Ennis the poor relation of these hospitals when €600,000 has been awarded by the mid-western hospital development trust for a scanner?

In case she is in any doubt about the value for money that can now be had for 16-slice scanners, I wish to inform the Minister that a Siemens Emotion 16 scanner has a high diagnostic image quality and, according to Medical Technology Business Europe newsletter, "enables hospitals and private practices with limited budgets or space allocations to install a 16-slice computed tomography (CT) scanner suitable for comprehensive clinical applications". That is all we want for Ennis. It would fit into a space of less than 200 sq. ft. and I believe the purchase price would not be much more than what the hospital has received from the trust fund.

I ask the Minister of State as the representative of the Minister for Health and Children to put pressure on the Minister to take into account a technology which is changing rapidly. The consultants advise that a 16-slice scanner is the minimum needed for Ennis and not a six-slice scanner.

My party leader was in Ennis last week and he visited Ennis General Hospital. He was told this information by the consultants. He also gave a commitment that a consultant-led 24 hour accident and emergency service would continue in Ennis General Hospital under his leadership.

I hope the Minister of State will have positive news for me this evening and that the Department will consider this proposal in the interests of patient safety and in the interests of promoting Ennis General Hospital where it is still awaiting the development plan to be implemented. A sum of €30 million has been allocated for this purpose but not a brick has been laid yet. We are hoping for good news in the near future. The recent news about the scanner does not bode well for a positive outlook for the future of the hospital and the Government's commitment to the hospital.

Photo of Brian Lenihan JnrBrian Lenihan Jnr (Minister of State, Department of Education and Science; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Health and Children; Dublin West, Fianna Fail)
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I thank Deputy Pat Breen for raising this matter on the Adjournment. I am making this reply on behalf of my colleague, Deputy Harney, the Minister for Health and Children.

As the Deputy is aware, the provision of services at Ennis General Hospital is the responsibility of the Health Service Executive.

With regard to the CT scanner, the Health Service Executive has informed the Department that the mid-west hospitals trust has agreed to provide funds towards the purchase and installation of a CT scanner at Ennis General Hospital.

The Health Service Executive has carried out a review of the CT scanner requirement. The number of CT procedures continues to grow in Ireland year on year. The hospital has been given approval by the HSE to purchase a six-slice CT scanner. The HSE is currently considering the revenue requirement for the new scanner and the cost of operating the scanner on a current basis.

People from County Clare currently have to travel to Limerick or Galway for a CT scan. The provision of CT scanning facilities at Ennis General Hospital will mean people from County Clare can receive CT scans in Ennis. The new CT scan will also have a significant effect on the workload of the regional hospitals. It must be noted that the more commonly required CT scans account for close to all of the scans required in county hospitals.

Common CT examinations such as pelvic and abdominal, brain, head and neck, chest and spine studies account for most of the CT procedures required. The use of multi-slice CT scanning for specialty procedures, such as vascular and cardiac CT procedures, made up less than 5% of the total number of CTs performed internationally and exclusively in large tertiary hospitals. The Health Service Executive envisages that multi-slice 64-slice scanners will be installed in the major teaching and regional hospitals to facilitate specialty scanning, particularly in the area of cardiology.

In the past year the Health Service Executive has taken the approach that CT scanning be available in its general hospitals to provide the more commonly ordered CT scans and studies locally and relieve the demand on the tertiary centres. In 2005, the Health Service Executive gave approval to proceed with the installation of six-slice CT scanners at a number of hospitals.

Costs rise significantly as the number of slices increase. In addition the six-slice scanner is considerably more robust than the higher slice capacity units resulting in less down time. For the type of scans being carried out, it is a more efficient scanner.

In addition to the provision of a new CT scanner in Ennis, a major new development at the hospital is at planning stage. A project team was set up to identify priority developments at the hospital so that the long-term requirements of the county can be addressed. The priority areas for development in phase 1A include the upgrade of wards, the accident and emergency department, the radiology department, including the CT scanner, the outpatients department, the intensive care unit, the concourse and a general infrastructure upgrade. These developments will cost more than €30 million to design, build and equip.

The Health Service Executive has recently issued approval to progress the design of the project to stage three, subject to the functional content of the planning brief being reviewed following the outcome of the review of the acute hospital services in the mid-west.

The Government is investing capital funding of more than €550 million on 400 individual health projects this year and more will be invested in 2007. We are committed to developing county hospitals such as Ennis to provide appropriate services for the people in County Clare. The Minister's policy is to provide safe, high quality services that achieve the best possible outcomes for patients. This will mean that those services that can be safely delivered locally are delivered locally. More complex services that require specialist input are concentrated in regional or national centres of excellence.