Wednesday, 25 June 2008
We want to know what is happening in Cork University Hospital in terms of the relationship between management and consultants. We also want to know whether the contents of a leaked e-mail are true. I suspect the Minister will tell us this evening that the consultants and management at Cork University Hospital have resolved their differences and are now moving on and getting on with their job. That is not good enough. Either management or the consultant was wrong. We need to know the truth; the public has a right to know.
There were disturbing reports in the Irish Examiner at the start of the week, with extracts from a leaked e-mail written by a consultant plastic surgeon, Mr. Jason Kelly, who described the hospital as being in crisis and miserably failing patients:
The article states:
The correspondence [. . .] highlights how on just one shift, one critically ill woman was left without morphine on an A&E trolley after undergoing an emergency breast removal. A second patient, a 70-year-old, had to wait five hours for an emergency amputation of her forearm after a "devastating injury"." The email describes how the 42-year-old woman "was admitted with a full thickness burn to her left breast and arm pit — it resembled a battlezone injury. She spent the night outside the plaster room in A&E. She did not get any morphine and her dressings were inadequate. She was also critically ill and did not receive adequate nursing care". Similar incidents at A&E "have happened before", the surgeon wrote, and "I have taken them through the usual channels without any obvious resolution". The surgeon says problems at the hospital need to be "fixed immediately".
He expresses concern at the proposal to move breast cancer services from the South Infirmary-Victoria University Hospital to CUH, adding a further 300 or 400 breast cancer patients a year when its operating theatres cannot cope with the existing workload. What is happening at CUH? Is it true that the hospital cannot deal with its existing workload? Is it the case that the two patients were treated as outlined in the e-mail?
All consultants at CUH held an emergency meeting following the publication of the article in the Irish Examiner on Monday. They formally backed their colleague, standing over the claims that were made. The response from management at the CUH stated that the accusations were erroneous and inaccurate. We want to know if the Minister of State is satisfied with the resolution agreed.
I congratulate the Irish Examiner on its courage in publishing the story on Monday and the journalist, Ms Claire O'Sullivan. Much of the content of Mr. Kelly's e-mail has been denied by senior management at CUH but since that denial the consultant group has stood by Mr. Kelly's report of systematic failures at the hospital and disagreed fundamentally with statements coming from the management at CUH. They are demanding a review of the management structures.
I have been an advocate of strong management boards in our acute hospitals and I advocated it during my time as a member of the southern health board. This proposal has been rejected by management and consultant representatives on a number of occasions. We are hearing two sides of the story but the patients' story is not being told. It is important that future developments include representatives of the patients on the management boards. CUH is a major hospital on an overcrowded site but is sucking in services from other hospitals, such as breast cancer services from the South Infirmary-Victoria University Hospital and cardiology services from the Mercy Hospital. The Minister for Health and Children has given the go-ahead to a private hospital on an overcrowded site.
Where is the Minister for Health and Children and why is she hiding from her responsibilities? Where is the required leadership? Going down a level from ministerial accountability, Professor Drumm visited Cork recently but failed to make a statement of clarification on any of the issues affecting health services in the Cork area. There is an agenda to downgrade the South Infirmary-Victoria University Hospital and the Mercy Hospital in favour of an overcrowded site at CUH. Bureaucrats are making decisions on balancing budgets rather than dealing with the needs of people. This is a scandal.
Another scandal is the advertisement by the Mercy Hospital of a 2,000 sq. ft. clinical space available in the hospital. Is this advertising the rental of St. Catherine's ward, which closed with the loss of 31 beds and which is due to reopen at the end of the year? Will we ever see St. Catherine's ward reopen in light of the recent advertisement seeking interested parties to take on the space? There is more happening in Cork than meets the eye. The Minister for Health and Children should come into the Chamber to tell those who represent the people of Cork what is happening. People protest in the streets because they are not getting answers. We should get answers in this House, otherwise we are failing those whom we represent.
I wish to share time with Deputy Ciarán Lynch. Last Tuesday, Professor Drumm and the Minister for Health and Children appeared at a meeting of the Joint Committee on Health and Children. I put questions to both and was dismissed as if I did not know what I was talking about.
I referred to the two theatres at the maternity hospital, which is a magnificent facility, that have never been opened. I spoke about two consultants there, one of whom told me he is drained by the constant battling with management to get more resources so that he can deal with his private and public list. Both told me they could clear their lists within a 12-month period if they had the theatre space available. In any week, they told me there are ten consultants waiting for theatre space who cannot get it. This is happening in the same hospital that Professor Drumm told me had no problem and should get about its business. If we believe the Minister and Professor Drumm, we are looking at additional consultants who will sit around drinking coffee because there is no theatre space in Cork in which to operate. This is what happened with Mr. Kelly. An unfortunate woman, who must have been in pain and quite traumatised by her injuries, had to wait five and a half hours to find a space in a theatre. It was not that the consultant was not available — the theatre space was not available. This is the same theatre space that Professor Drumm told me there was no problem with.
The question that must be answered is straightforward. Someone is telling the truth and someone is telling lies. There can only be one person telling the truth because the two statements contradict each another dramatically. An entire team of consultants and medical staff say that this happened, that it happens regularly and that the hospital is in crisis. These people have nothing to gain from this being made public. They must return, work under the same conditions and treat people every day and night.
On the other hand, the manager says that there is nothing wrong, that the e-mail is erroneous and that it never happened. The manager needs to say that because it looks as if the hospital is doing well and that nothing is wrong. There are two conflicting statements and someone must be telling the truth. I know who I believe. There should be a board of management established in what is a major industry, given the numbers that work in it. Where is the Minister for Health and Children? Absent, as usual.
We have nothing short of an unprecedented crisis at the CUH. Last week I questioned the removal of the breast cancer unit from the South Infirmary-Victoria University Hospital to the CUH. The question has been answered tonight. There has been a litany of mismanagement at CUH over the past three years, in respect of referral rates to the national treatment purchase fund, which are the worst in the country, the opening of the maternity unit, the gynaecological services and an overdeveloped, inefficiently run campus. It is proposed to place a co-located hospital on the site. Serious questions must be asked. The Minister has abdicated her responsibilities on managing the health service through the HSE and the managers are now abdicating their responsibilities, apparent by their removal from the operation of the hospital itself.
I thank Deputies Simon Coveney, Kathleen Lynch, Bernard Allen and Ciarán Lynch for raising this important matter. I assure the Deputies that the Minister and the HSE are committed to the highest level of patient safety in our hospitals and throughout the health service. The issue of safety in the delivery of health services lies at the heart of any care system which has the confidence of the people using these services. While the health sector is one of the most complex areas of activity in every country, it must by its very nature command the confidence of those who use it. To obtain this confidence, the measures which must be undertaken are fundamental. The patient safety and quality agenda is, in effect, fully prioritised.
Two major initiatives in the past 18 months have addressed and reinforced this message. In May 2007 the Health Information and Quality Authority, HIQA, and the Office of the Chief Inspector of Social Services were established to bring about a safer health and social services system which embeds quality at all levels and in all settings. HIQA is responsible for setting and monitoring standards across health institutions and services in the public sector.
In January 2007 the Minister established the Commission on Patient Safety and Quality Assurance. One of its functions is to examine and develop proposals for a health service-wide system of governance based on corporate accountability. Other key areas which the commission is examining are clinical audit, critical incident reporting and the participation of patients and carers in health service planning and provision of feedback on quality of care. The commission is expected to report by July 2008. The Minister looks forward to receiving this report, which will build on and inform the further development of the current system. The foregoing initiatives are firm indicators of the Minister's commitment in the area of patient safety.
Cork University Hospital is the largest acute hospital delivering health care in the HSE southern region. It is a multi-specialty hospital in which many clinical and infrastructural challenges are faced on a day-to-day basis. The hospital has more than 26,000 admissions each year, excluding day cases, with more than 50% of these patients admitted via the emergency department. The Minister was concerned to learn in recent days of the matters which the Deputies have raised this evening with regard to the alleged lapses in the care provided recently to two patients at Cork University Hospital. The HSE has advised the Minister that Cork University Hospital operates a quality and accreditation programme which incorporates a process for managing adverse incidents for patients and staff. The Minister understands that the general manager, together with senior nursing, medical and clinical governance personnel at the hospital, and of the HSE southern region, has undertaken a detailed investigation of the matters concerned and is satisfied that the care in these cases was appropriate.
The HSE advises that the key facts regarding the care of the two patients in question are as follows. With regard to the woman who was alleged to have waited an inordinate amount of time for an amputation operation, from initial notification of the theatre team to their achievement of a state of readiness to accept the patient, the time elapsed was one hour and 25 minutes, not five hours as may have been suggested.
In so far as the second patient is concerned, the HSE has indicated that she was admitted on the patient administration system at 2.11 p.m., first received morphine within 20 minutes and was administered additional doses of the drug after that time. She also received one-to-one special nursing care prior to her admission to theatre and afterwards.
This afternoon, the HSE personnel involved met with medical staff at the hospital. The division of plastic and maxillofacial surgery met with the executive management board, the membership of which includes three consultant clinicians including the chairman of the consultant medical staff, general manager and the director of nursing. Arising from this, the HSE has advised that all parties concerned regret the potential for misrepresentation consequent upon the leaking of correspondence, subsequently interpreted out of context and without the consent of the parties concerned.
On a point of order, what the Minister of State is saying is meaningless. Will she appoint an independent investigator to examine all aspects of this case? As Deputy Kathleen Lynch stated, somebody is telling lies here.
The HSE accepts that patient advocacy is the prerogative of all staff and that the consultant in question acted and continues to act in the best interest of patients at all times.
Independent of the events of the past few days, Cork University Hospital has been developing and continues to progress structures that reflect the scale and complexity of the hospital. The intention of the executive management board is to implement governance structures which will have flexibility and innovation to respond to the continuing challenges of health care delivery. This is being done in the context of the hospital being selected as an exemplar site for the implementation of the clinicians in management programme being developed by the HSE in the context of the new consultant contract. This will involve a reorganisation and restructuring of the current clinical divisions and the participation of key staff in the leadership development programme.