Dáil debates
Wednesday, 28 January 2009
Adjournment Debate
Accident and Emergency Services.
8:00 pm
Joe Carey (Clare, Fine Gael)
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Prior to the last general election, the then Taoiseach, Deputy Bertie Ahern, gave a public commitment to the people of County Clare. Fianna Fáil candidates in that election gave the same political commitment in all debates that 24-hour accident and emergency services would be retained at Ennis General Hospital and that the hospital would finally receive a capital development allocation of €39 million. These commitments have been given by the Government since 2000, and they ring hollow in 2009.
The people of Clare should have the best possible health care service delivering the best possible medical outcome. Placing 44,000 Clare people outside the reach of golden hour cover is not the answer. Asking people to travel 60, 70 or 80 miles to an accident and emergency department is not the answer. This argument aside, there is insufficient capacity at the Mid-Western Regional Hospital in Limerick to cope with the extra workload. Where are the 135 beds promised for Limerick? Where are the new ambulances? The new plans provide for eight accident and emergency consultants based in Limerick. There are currently only three with a potential for five, but the two additional posts will not be filled for 18 months.
Instead of creating a centre of excellence in Limerick, a centre of chaos will arise. One need only look at the result of the Government's attempt to centralise services in the north east. In recent weeks, sick people have been lying on trolleys for three days in Our Lady's Hospital in Drogheda. Surgery has been cancelled, there are insufficient beds and medical staff are extremely frustrated.
I plead with the Minister for Health and Children to listen to those at the coal face, to GPs, consultants, nurses and ambulance crews. All these staff groupings have expressed serious concern about the situation, with one consultant threatening to resign. The Minister must learn from the mistakes made in the north east instead of pushing more patients towards the Mid-Western Regional Hospital in Limerick, which is already bursting at the seams. The Minister must abandon her plans for the mid-west and abandon this general slash and burn approach. Instead, she must honour the political commitments made by the Government to the people of County Clare.
Noel Coonan (Tipperary North, Fine Gael)
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Taking services out of a community before putting alternative services in place is a classic case of putting the cart before the horse. The Teamwork report estimates it will cost €380 million to implement this change. However, only €6 million has been allocated to Mr. Paul Burke, the person charged with implementing it. The services are simply not in place at the Mid-Western Regional Hospital in Limerick. The promised additional 135 beds have not been provided and the additional ambulance and paramedical staff are not in place.
I regret the absence of the Minister of State with responsibility for older people, Deputy Hoctor, from the Chamber. I appeal to the Minister of State who is in attendance, Deputy Moloney, not simply to make new claims that funding is promised for various services. The public has grown tired of the broken promises of Fianna Fáil and the Minister for Health and Children, Deputy Harney. A 20-bed long-stay facility for Borrisokane was included in the capital funding programme last year. This funding was withdrawn on 31 December 2008 and must be reapplied for. The ambulance spaces promised for Thurles and Nenagh — as part of the Government deal with Deputy Lowry, as we were told — have not been delivered. The promised paramedical staff have not been trained and an air ambulance has not been provided.
The Minister of State, Deputy Moloney, is aware that parts of north Tipperary are not accessible to Limerick within the golden hour. This is of great concern to the people of that area and they will not accept it. We will fight tooth and nail on this issue. To paraphrase the words of the Bull McCabe to his son Tadhg, "Do not do it, Minister". Laois people have always been decent to the people of Tipperary and we ask the Minister of State to support us in our battle to retain vital services in north Tipperary. The theory of such proposals is fine but the reality is entirely different. If the services are seen to be in place and operational in Limerick, the people of north Tipperary may reconsider.
9:00 pm
Pat Breen (Clare, Fine Gael)
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The engineers who designed the Titanic said it was unsinkable but it sank on its maiden voyage. The Teamwork report will also sink on its maiden voyage because it is based on a perfect world and a perfect health service which do not exist. The report makes no reference to funding. In the current economic climate, nobody believes the Government has any intention of providing the necessary funding.
If the Health Service Executive proceeds to implement this report without the full capital expenditure, people will die. This is not scaremongering. One life lost as a result of the implementation of this report without the provision of the necessary funding will be one life too many. This report is not concerned with putting the patient first or reshaping local services in line with the needs of the local population. Rather, it is concerned with cutting costs and removing services from Ennis and Nenagh hospitals. No sooner was the ink dry on the report than the implementation team was put in place. Another plan is being hatched as we speak to remove services from Ennis as soon as possible.
Not one hand was raised in support of these proposals when GPs from Clare and Tipperary met yesterday. These are the people who work at the coal face of the health service and who understand the issues. The Minister, Deputy Harney, said yesterday in her response to a parliamentary question of mine that detailed plans are being formulated by the Health Service Executive in regard to emergency care, critical care and surgical services and that certain changes to current arrangements for the provision of some acute services will be made.
The people of Clare want a 24-hour accident and emergency service to be retained at Ennis General Hospital. There is genuine fear and concern among those living in west and north Clare that they will be further isolated from the provision of vital life-saving services. If this report is implemented in full, Ennis General Hospital will become a minor injuries clinic. A group of six advanced paramedics based in Ennis will be expected to deliver a 24-hour emergency care service throughout the county. The existing ambulance service is already starved of resources. If the Health Service Executive and the Minister are serious about providing funding, they must increase the number of proposed advanced paramedics and install them on a 24-7 basis at each of the ambulance stations at Kilrush, Ennistymon, Scariff and Ennis.
My colleagues and I are elected to represent our constituents and we demand answers on their behalf. The Minister, Deputy Harney, has the ultimate responsibility and she must come clean with the public. If we cannot obtain answers in the Chamber tonight, we will persist in our efforts to oblige the Minister to debate this issue in the House. I am disappointed she is not here for this debate. She should be in attendance to answer our questions.
John Moloney (Laois-Offaly, Fianna Fail)
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I am responding to the Deputies on behalf of the Minister, Deputy Harney, who cannot be here.
The Government is committed to ensuring the delivery of the best quality health services possible, in an effective and efficient way, and ensuring patient safety is of paramount importance in order that people can have confidence in the services and the best possible patient outcomes can be achieved.
There is significant international and national evidence that acute complex health care, particularly for emergency medicine, complex surgical services and critical care, should be provided in hospitals which are suitably staffed and equipped and which undertake sufficient volumes of such activity in order to maximise clinical outcomes and, more important, ensure safe services. At the same time there is a significant range of less complex care which can continue to be provided safely in smaller hospitals.
Reorganisation of services must occur in consultation with the key stakeholders and on an incremental basis.
Seymour Crawford (Cavan-Monaghan, Fine Gael)
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That never happens.
John Moloney (Laois-Offaly, Fianna Fail)
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It does. I have seen it happen in the midlands and I am quite certain it also happens here.
John Moloney (Laois-Offaly, Fianna Fail)
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I make the point that reorganisation will occur in consultation with all the stakeholders, which would include the GPs. The Minister believes that it is important to work with health professionals and other interested parties to secure an increasing set of improvements over time. She is confident this approach will produce the best outcome for patients.
It is also important to note that the HSE has commissioned a number of reviews on how acute hospital services should be organised, including the Teamwork-Horwath report on the mid-west region, which the executive has recently published.
The Teamwork-Horwath report on the mid-west highlights the need for changes to be made in the provision and organisation of acute hospital services across the region, particularly in regard to accident and emergency services, critical care, acute surgery and medicine. It is also worth noting that the report found that the services are too fragmented, carry increased risks for patients and staff and are not sustainable in their current form.
The HSE has also indicated that certain changes to the current arrangements for the provision of some acute services, including accident and emergency services, must be made, in the interests of patient safety and also to make best use of the clinical resources available within the mid-west region. The HSE has been engaged in a consultation process with key stakeholders as it formulates detailed plans in regard to emergency care, critical care and surgical services in the region.
The HSE plans will involve the reconfiguration of acute hospital services into a network and their better integration with primary care services across the region, with a regional centre at Limerick Regional Hospital that will deal with complex and specialist cases. The plans will also provide for the development of significant and effective local hospital and community services. These will include important roles for Nenagh General Hospital and Ennis General Hospital which, for example, will involve the expansion of day surgery and diagnostic activity.
John Moloney (Laois-Offaly, Fianna Fail)
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If the Deputy follows the script, he will note the position is otherwise. The Minister emphasises and confirms that there will be important roles for Nenagh and Ennis.
Noel Coonan (Tipperary North, Fine Gael)
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They are like the centre of excellence in Portlaoise in the Minister of State's constituency, the Government did not invest the necessary funding in it.
John Moloney (Laois-Offaly, Fianna Fail)
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No, the Deputy is wrong about that. I supported the then Minister who selected Tullamore. The funding is in place and the service is up and running.
Noel Coonan (Tipperary North, Fine Gael)
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Portlaoise was designated a centre of excellence.
John Moloney (Laois-Offaly, Fianna Fail)
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In regard to accident and emergency services, it is important to appreciate that, although these departments are staffed on a 24-hour basis, the number of attendances in Ennis and Nenagh between 8 p.m. and 8 a.m. is low.
Joe Carey (Clare, Fine Gael)
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Some 21,000 people attended the accident and emergency department in Ennis.
John Moloney (Laois-Offaly, Fianna Fail)
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That does not stack up with the facts I have here. In Nenagh the average number of attendances in this period is 7.6, while the corresponding number in Ennis is 9.2. Most of these cases would be more appropriately dealt with by GP out-of-hours services.
Noel Coonan (Tipperary North, Fine Gael)
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Some 19,000 people attended the accident and emergency department in Nenagh.
John Moloney (Laois-Offaly, Fianna Fail)
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The HSE plan will reorganise the arrangements in Ennis and Nenagh so that these hospitals will provide an urgent care service for 12 to 14 hours a day as part of a regional accident and emergency structure. These hospitals will also continue to admit appropriate medical cases. The HSE has identified the enhancement of emergency ambulance services as an essential element of the new service delivery arrangements for the mid-west.
John Moloney (Laois-Offaly, Fianna Fail)
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Agreement has been reached with the ambulance service that all trauma, paediatric and obstetric emergencies will not be brought to the local hospital but will go directly to the major tertiary centre, which includes the regional maternity unit.
Plans are under way to introduce a 24-hour advanced paramedic service in Clare and north Tipperary.
Pat Breen (Clare, Fine Gael)
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There are only two paramedics on duty at any stage. How can two cover an area?
John Moloney (Laois-Offaly, Fianna Fail)
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Plans are under way to introduce a 24-hour advanced paramedic service in Clare and north Tipperary.
Pat Breen (Clare, Fine Gael)
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Six are assigned for the entire county, but how can that number cover the county if one of them is out ill?
John Moloney (Laois-Offaly, Fianna Fail)
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Advanced paramedics are trained to a standard that equips them to provide more complex pre-hospital care than ordinary paramedics. This includes the administration of a wider range of drugs and the urgent assessment and resuscitation of patients.
Pat Breen (Clare, Fine Gael)
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The Minister of State should tell that to someone from Kilbaha or Carrigaholt.
John Moloney (Laois-Offaly, Fianna Fail)
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The strategy is all about providing the best care for patients.
Paul Connaughton Snr (Galway East, Fine Gael)
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It is all about money.
John Moloney (Laois-Offaly, Fianna Fail)
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In regard to capital development, the Minister has asked the HSE, in the context of the development of its capital plan, to consider the requirements of the mid-west arising from the planned reconfiguration of services in the region.
John Moloney (Laois-Offaly, Fianna Fail)
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Deputies will also be more than satisfied to realise that discussions on the HSE draft capital plan are ongoing between the executive and the Department. The Minister is satisfied that the measures being taken by the HSE are necessary and appropriate in order to ensure the provision of safe and effective health services to the people of the mid-west region.