Dáil debates

Thursday, 17 April 2008

5:00 pm

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Every week since the Dáil resumed at the start of this year has brought news of more cuts in our public health services as a result of the disastrous policy of this Government and disastrous management by the Health Service Executive. These cuts have come on top of the policy of over-centralisation which attacks the services provided at local hospitals. Nowhere has this been done more ruthlessly than in counties Cavan and Monaghan where our two hospitals are now facing what consultants at Monaghan have described as "a catastrophic situation."

What is the Minister for Health and Children doing about this? She is driving it. Her priority is privatisation. Next week, on 24 April, the Minister will open a private health conference in Dublin and participants will pay more than €500 each to attend this exclusive event for private health profiteers. Meanwhile, our patients are suffering and our public hospitals are being downgraded.

The latest crisis for Monaghan General Hospital has been provoked by the attempt of HSE management to discontinue the ventilation facility at Monaghan General Hospital which was due to close on 7 April. The closure has not taken place because consultants at Monaghan are refusing to operate proposed new protocols for the treatment of patients requiring acute care. The consultants say that the removal of the ventilation facility will lead to the ending of all acute medical admissions in Monaghan resulting in "mortality for patients".

Correspondence from the consultants at Monaghan General Hospital to Health Service Executive management shows that the hospital is facing, in the words of the medical professionals, "a catastrophic situation". If the HSE is allowed to proceed with its plan to end all acute medical admissions at Monaghan General Hospital, then facilities will have to be found for the treatment of the 3,000 per annum acute medical admissions to Monaghan. The main burden will fall on Cavan General Hospital which already has to cater for 5,000 such admissions per annum and which currently has 160% bed occupancy. In other words, it has 60% more patients awaiting beds than there are beds available in the hospital.

The consultants make clear that with only some 25 additional beds proposed for Cavan, the proposed downgrading of Monaghan is totally untenable. I commend the Monaghan consultants for refusing to agree and operate the protocols proposed by the HSE. As a result of their stand, the HSE has not been able to enforce the closure of the Monaghan ventilation facility.

An existing protocol, not previously known publicly, states that Monaghan is only allowed to have three patients on trolleys awaiting admission at any one time. If a fourth patient presents he or she must be moved to Cavan or another hospital. This has nothing to do with patient care. All it does is disguise the true need and demand for the services at Monaghan. In the first three months of 2008 some 78 patients were moved from Monaghan in this way. It is interesting to note that 18 patients left Monaghan untreated rather than go to another hospital. This protocol serves only to disguise the true need and demand for services at Monaghan General Hospital.

Just as significant as the strong protest from the consultants about the proposed ending of acute medical admissions is their assertion that since returning "on-call" in 2005, Monaghan General Hospital has functioned very well and provided a high standard of care to patients with acute medical illnesses. This reflects the positive experience of the overwhelming majority of people, this Deputy included, in the area served by the hospital.

All of this unquestionably gives the lie to the utterly false and misleading claims by HSE management and the Minister for Health and Children, Deputy Mary Harney, that the downgrading of Monaghan General Hospital is based on patient safety and achieving better standards of care. It is clearly no such thing. It is driven by cost-cutting and a ruthless centralisation agenda. The HSE is enforcing flawed strategic plans in the most high-handed manner, regardless of the impact on patient care. This correspondence exposes how bureaucrats have sought to enforce protocols for the care of patients against the wishes of the medical professionals who have to deliver that care.

The implications of the HSE plans are very serious for Cavan General Hospital. It will not be able to cater for 8,000 acute medical admissions per annum. Any notion that somehow Monaghan's loss is Cavan's gain is totally spurious. Patient care in both counties and in the north-east region will be adversely affected. For the sake of both hospitals and all who depend on them these plans must be resisted.

GPs in County Monaghan have written to Mr. Stephen Mulvaney, network manager of the HSE in the north-east region, and they state that patient care is not at the centre of HSE decision making. Those are the professional colleagues of the Minister of State, Deputy Devins.

Monaghan General Hospital is the victim of political decision-making on health care at Government level which takes no account of the reality of people's lives. I will conclude by making it abundantly clear that I will continue to challenge the Taoiseach, the Minister for Health and Children, Deputy Mary Harney, and all their Fianna Fáil and Green Party Government colleagues on this matter and I urge people throughout counties Cavan and Monaghan, irrespective of their political affiliation or none, and beyond both counties and that region, to challenge Government and Government-supporting Deputies on this disgraceful set of proposals which will be a template employed on hospital networks throughout the rest of the jurisdiction.

Photo of Jimmy DevinsJimmy Devins (Sligo-North Leitrim, Fianna Fail)
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I am taking this matter on behalf of my colleague, Deputy Mary Harney, Minister for Health and Children. I thank Deputy Ó Caoláin for raising this issue.

The Health Service Executive north-east transformation programme involves widespread and fundamental change and is designed to build a health system that is in line with the model of care emerging internationally. The programme is expected to deliver an integrated care system with local and regional hospitals functioning within a co-ordinated, integrated clinical network as part of the wider system of primary, community and continuing care. Its overriding aim is to improve safety and achieve better standards of care for patients in the region.

The HSE has advised that the north-east transformation programme is approaching the end of its initial phase of detailed planning and is moving towards detailed design and implementation. Operational management and transformation management arrangements in the region have now been linked in order to achieve full integration of the transformation programme with the management of operations. The HSE has emphasised its commitment that existing services in the region will remain in place until they are replaced with higher quality, safer or more appropriate services. The HSE further advises that no decisions have been taken on reducing services in the north east.

The HSE is facing a challenging year and is exploring, in the case of the north east, how best to deliver on service plan targets within the level of resources available. The Teamwork report clearly states that there is a role for all five hospital sites in the development of acute hospital services in the future. The report clearly indicates that the current service configuration is unsustainable and that there needs to be a reconfiguration of hospital services across the five hospital sites and, ultimately, the development of the new regional hospital in order to ensure the highest level of patient safety.

There are a number of factors influencing the direction of these developments, not least the need to ensure that there are fully trained teams of emergency medical and surgical staff available to deal with the most complex cases which will present in the region. In the case of Monaghan General Hospital there have been a number of significant improvements, including two newly refurbished inpatient medical wards. This project, which cost €5 million, consists of two 25 bedded in-patient wards — male and female — with each ward providing a range of multi-bedded and single rooms. The ward project builds on the investment of €1.2 million on new equipment, an upgrade of the pharmacy and general facility upgrades for the hospital.

The HSE envisages that the role of Monaghan General Hospital in the future will be to provide a range of diagnostic, outpatient, day cases and some in-patient treatment services within clinical networks. Significant developments have also taken place in the provision of surgical services across the Cavan-Monaghan Hospital interface. Emergency surgical services on a 24-hour, seven day basis are provided on the Cavan site while significant elements of diagnostic, outpatient and day case services are provided on the Monaghan hospital site. This has resulted in lower waiting times for outpatient appointments and inpatient elective services. Since the reconfiguration of Cavan-Monaghan surgical services, patients can be seen by the visiting consultant surgeon on the day of referral by the general practitioner. The HSE has indicated that the relevant clinical protocols for the development of a minor injuries treatment unit at Monaghan hospital are currently being developed by the emergency care clinical network in conjunction with Cavan-Monaghan hospital group management.

Monaghan hospital will continue to have an important role to play in the provision of health services in the north east. This view was confirmed in the Teamwork report and also in the north-east transformation programme.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Protocols are being developed by management. Does anything else say it as clearly?

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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It is with particular sadness that I speak today. A young expectant mother, who lived in the same estate as myself, died in childbirth. Her family and the wider community were in shock and deeply saddened. Let me, therefore, first express my sympathies with the family of Tania McCabe — her husband Aidan, their children, and the families of Aidan and Tania.

When this happened my personal amateur, non-medical reaction was that it must have been the kind of devastating and unfortunate accident which sometimes happens in medical practice. As a nurse, my wife's immediate reaction was that this should not happen in Ireland or in the western world. How right she was. This should not have happened in Ireland.

A report made by the HSE was leaked, as usual, to the media before we legislators saw it, although in this case it seems the family saw it before it reached the newspapers, unlike other cases such as the recent cancer scare. The report paints a devastating picture of the quality of maternity services at Our Lady of Lourdes Hospital in Drogheda. According to newspaper reports, which are what I must rely on, staff shortages, high workloads and systems failures contributed to death in this case.

Will this happen again? As a father of a child born in Our Lady of Lourdes Hospital in Drogheda six months ago, and who has such hopes for some time in the future, I have no reassurance. The Government, as the Minister of State, Deputy Devins, will be conscious, has a duty to protect our people. I have regularly defended medical services at the hospital and I will continue to defend and praise the midwives and doctors, many of whom I know, but I cannot stand over the systems and the numbers of staff in place. According to newspaper reports, the HSE report states — speaking of the medical staff in general, I think — that their practice and, ultimately, the care that they provided to Tania was compromised by their workload and the environment in which they were working.

The report also identifies shortcomings in record keeping, according to the media. This seems to be a perennial problem when we come to hospital issues. The HSE press release says the HSE will move quickly to look at the recommendations on how best to approach their implementation. This has been said before and must be said. We have heard from the Kinder task force, An Bord Altranais, Judge Maureen Harding Clark and the medical board of the hospital itself. A consultant recently offered to pay for staff out of his own salary. People die in hospital, but in this case it seems that HSE systems contributed to the death in question. I say "seems" because we are relying on media reports and I do not want to intrude on the family's grief.

I will paint a picture of the estate in which we live. It is a brand new estate of perhaps 1,000 houses. Many of the people who live in the estate are, like my wife and I, young couples with young children. There are lots of mothers on maternity leave walking around the estate with their newborns. They are very happy people. One home in that estate has been left bereft of a wife and mother. It is a very sad situation. The Government and myself, as a Deputy for that area, estate and constituency, have a responsibility to get things right.

Photo of Jimmy DevinsJimmy Devins (Sligo-North Leitrim, Fianna Fail)
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I am taking the matter on behalf of my colleague, Deputy Mary Harney, Minister for Health and Children. I thank Deputy Thomas Byrne for raising this very sad issue and extend my sincere sympathies to the family of the deceased at this difficult time.

I understand that an internal review of the circumstances pertaining to the death of the lady concerned and her infant son at Our Lady of Lourdes Hospital, Drogheda was carried out. The scope of the review covered the period from the woman's first antenatal specialist consultation in November 2006 to the time of her death and the death of her son in March 2007. The review team was chaired by a consultant obstetrician and its membership included a consultant anaesthetist, a director of midwifery and the risk assessor for the HSE north east. The review group was asked to examine protocols and procedures relevant to the incident, taking into account prevailing standards of best practice, and to prepare a written report for the HSE north east hospital network manager to include such recommendations as it saw fit.

The Department is advised that the review has now been completed and that the resulting report has been given to the family. The family has also been offered professional support at this most difficult time. Relevant hospital personnel have also been briefed on the contents of the report and its recommendations. The HSE has said that it is assessing the recommendations as a priority. I also understand that the coroner is due to hold an inquest in respect of the case.

The enhancement of maternity service provision and development in Our Lady of Lourdes Hospital is being addressed. For example, three additional consultant anaesthetists were appointed in 2007, which has facilitated the provision of dedicated consultant anaesthetist obstetric cover seven days per week. The HSE has also approved an additional 22 midwives. This has raised the approved midwifery staffing complement to 88.6. I understand that all but six of these posts have been filled. Along with the increases in staffing levels, the HSE advises that it has strengthened the governance and communications structures to address some of the main issues highlighted during the review. I understand that the Minister does not propose to comment further at this time out of respect for the deceased and the family.