Dáil debates

Wednesday, 17 December 2008

8:00 pm

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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In raising this matter, I am seeking to highlight the fact that, in the view of the 100 plus GPs who refer people to it, Mallow General Hospital is a centre of excellence. It is also a secondary care facility that caters for the needs of a population base of well over 100,000. If the national service plan, as envisaged, is implemented, the accident and emergency department at Mallow General Hospital will be downgraded to a minor injuries unit. The GPs from whom I have received representations and the people who live in the area want to know what will be the future of the accident and emergency department. There is a concern that if it is downgraded to the status of a minor injuries unit, many GPs in the area will bypass Mallow General Hospital and refer people instead to Cork University Hospital, CUH. Given an expected population base of 4.53 million in 2009, it is vital hospitals such as Mallow General Hospital maintain some coherence in terms of accident and emergency services. Reducing or diminishing it to a minor injuries clinic will result in more people being put into the narrow funnel that is Cork University Hospital, which is not the way to go.

I have taken advice on the matter from general practitioners who refer stroke patients and people with heart complaints to this hospital. Many of these interventions can be dealt with by the accident and emergency department. Downgrading the hospital to a minor injuries unit will have an adverse effect on outcomes for patients.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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I concur with what Deputy Sherlock said. A Teamwork report completed in the mid-west more than a year ago has not yet been published. There are all sorts of rumours going around about accident and emergency services at hospitals in Nenagh, Ennis and Limerick being reduced. There is no evidence whatsoever that capacity in the Mid-west Regional Hospital in Limerick will be increased to cater for extra patients. People living in places like west Clare will be a considerable distance from the central hospital in Limerick should this downgrading go ahead. We are hearing rumours to the effect that this will happen in March 2009.

I have repeatedly called for the publication of the Teamwork Management Services report and have received conflicting answers, some of which indicate the report has not yet been submitted to the board of the HSE and others from the Minister and Professor Drumm who indicated in committee that they do not want to publish it because it may give rise to opposition. This is no way to democratically address the issue of how we run our hospital services in this country.

It is important to state on the record that secondary hospitals have an important role to play. They are much more cost effective in dealing with certain matters than are tertiary hospitals. We need to have a proper debate and evaluation of the role of secondary hospitals before they are downgraded in some type of secret operation, with no publication of a plan and only a vague generalised reference to reconfiguration as set out in the HSE plan launched yesterday.

While a copy of the Teamwork report is floating around in the mid-west it has not yet been published. In effect, patients, the public and public representatives are being denied an opportunity to participate in a debate on this issue and to ensure we maintain a level of service in secondary hospitals in the mid-west, south, north-east and in various other parts of the country that is appropriate to what a secondary hospital can do. An excellent service is being provided by these hospitals in a cost effective manner in comparison with larger hospitals.

It is appalling that this is happening in a type of secretive manner without any public discussion. I urge the Minister to genuinely address the issues of concern in these areas because people do not know what is happening. I have spoken about the issue to people in Clare, north Tipperary and Limerick. They are hearing rumours about what is proposed for their hospitals but there is no public announcement in this regard. It is almost as if this is being done behind closed doors with only particular people being brought on board and senior rather than regular staff at the hospitals being told about it.

Photo of Éamon Ó CuívÉamon Ó Cuív (Galway West, Fianna Fail)
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I am responding to the Deputies on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The Government is committed to ensuring the delivery of best possible quality health services in an effective and efficient way. Patient safety is of paramount importance in ensuring people have confidence in the services and that the best possible patient outcomes are achieved. It is essential that patient safety and quality are prioritised and that services are organised and managed accordingly.

The six hospitals in the mid-western region providing acute services have a complement of 828 in-patient beds and 124 day beds. Between them, the hospitals have a total operating annual budget of €275 million, with a staffing complement of 3,248. The activity profile for the service consists of 47,000 in-patients, 34,000 day cases, 180,000 out-patient attendances and 110,000 accident and emergency presentations per annum. The maternity hospital deals with 5,500 births per annum. These figures underline the importance of the work done by the hospitals in the mid-west area and the contribution they make to the health services of the region.

Mallow General Hospital provides a valuable range of in-patient, out-patient and day case services. It is, and will continue to be, an important health care facility. In the past years, there has been a considerable level of investment in equipment and infrastructure at the hospital. A capital sum of €1.5 million was provided for the provision of CT scanning services at Mallow General Hospital on a five-day week basis. The support staff has been put in place and the CT scanner has been operational since September of this year. A refurbishment programme has also commenced at the hospital. Work on the upgrading of the emergency department has been completed and work on the extension of the regional laboratory system is about to commence. A sum of €260,000 was allocated in the current year for ward and other minor equipment, upgrading of toilets and compliance with hygiene and decontamination standards.

The HSE has commissioned a number of strategic reviews of the configuration of acute hospital services including in the mid-west and the south. In each case, the first priority is patient safety. The challenge in the years ahead will be to organise, manage and deliver high quality services that are focused in the first instance on the safety of patients. Horwath Consultants in association with Teamwork Management Services were commissioned by the HSE to work on the strategic reviews in the mid-west and southern regions. The reviews focus on identifying the best configuration of acute hospital services in the regions, including arrangements for accident and emergency, critical care, acute medicine and surgery, together with diagnostic services so that the highest quality of care can be delivered to the population of the regions concerned.

The HSE reviews will act as inputs to decisions on how best to reconfigure acute services in the regions concerned. The Government and the Executive are committed to ensuring that the approach to reorganisation of services is carried out in consultation with the key stakeholders and that each element is progressed incrementally.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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What about the public? Are they not key stakeholders?

Photo of John O'DonoghueJohn O'Donoghue (Kerry South, Ceann Comhairle)
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Please allow the Minister to continue without interruption.

Photo of Éamon Ó CuívÉamon Ó Cuív (Galway West, Fianna Fail)
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The Minister believes it is important to work with health professionals and other interested parties to secure an increasing set of improvements over time. This approach will, she is confident, produce the best outcome for patients. Patient safety will determine how services in the mid-west and the south are configured in the future.

A detailed planning process is currently underway in each network to ensure that secondary care services are assigned to each hospital in the network in an appropriate manner, which takes account of their ability to manage complex care safely and to the highest standard. The Government is committed to ensuring high quality acute services throughout the country.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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Gobbledygook.