Dáil debates

Tuesday, 31 March 2009

3:00 pm

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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Question 39: To ask the Minister for Health and Children if she intends to close Mallow General Hospital, County Cork; and if she will make a statement on the matter. [12819/09]

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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Question 87: To ask the Minister for Health and Children if there are plans to close hospitals here; and if she will make a statement on the matter. [13076/09]

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 39 and 87 together.

I have no plans to close any acute hospital. My priority is to ensure all acute hospital services are delivered to the highest standard of quality and safety to patients and in the most efficient way possible.

My aim is to make certain that we provide the right type of acute care in the right type of hospital. There is an abundance of expert medical advice that small hospitals with low patient volumes should not provide very complex forms of treatment. The best outcomes for the population will be achieved where complex care is provided in specialised centres where all of the necessary clinical expertise and facilities are immediately available. At the same time, developments in health care mean that smaller hospitals can meet much of the demand for less complex services, especially those that are increasingly carried out on a day case basis.

The review of acute hospital services for the HSE South by Teamwork consultants has recently been completed and will inform HSE plans for the reorganisation of acute hospital services in the region. The objective of the HSE is to ensure that there is a clinically safe and sustainable model of care. One of the key elements of reconfiguration will involve developing smaller hospitals to provide a much greater proportion of less complex care, especially in day surgery, medicine and diagnostics. With this in mind, I am confident that Mallow General Hospital will continue to play an important part in the provision of acute health care in the southern region.

I am pleased Professor John Higgins, a consultant obstetrician and gynaecologist at Cork University Maternity Hospital, has accepted the appointment of clinical project director for the reconfiguration process in the HSE South. The HSE will consult with key stakeholders in the region and Professor Higgins has commenced his work in this regard. The HSE proposes to publish the Teamwork review following the completion of the initial phase of this consultation process.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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I welcome the Minister's statement. This is the second time in a short period that the Minister has clarified the situation in respect of Mallow General Hospital. When will the Teamwork report be published? The reconfiguration document was published on 15 January and laid before the regional health forum. The document stated that the only services rotated through Mallow General Hospital would be outpatient and obstetrics and gynaecology services and no other services were envisaged. ENT services are now being cut, which does not tally with the Minister's statement. Will the Minister further clarify what day procedure services she envisages would rotate through Mallow General Hospital in future?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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Professor John Higgins has been appointed as the clinical project director. I met him last week. His task is to engage with the clinical community in the region and to reach agreement on what should take place in Mallow General Hospital rather than Cork University Hospital or the other hospitals in Cork or Kerry. I believe this has been a very successful process and it is working well in the mid west and the north east. Mallow General Hospital scored very well in the health statistics and the hygiene audit and I compliment those involved. Notwithstanding how well the hospital performed, there is room for improvement. It performed very well on average length of stay.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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There are a number of centres of excellence in Mallow General Hospital also.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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It is probably top of the class in the country in that regard. The national day case target is 75%, but in the case of Mallow General Hospital it is only between 30% and 40%. Its mix of public and private patients is very far off the mark. Some 50% of the surgical patients are private in Mallow General Hospital and, as the Deputy is aware, the national target is 20%. I hope that in the context of the reconfiguration the targets established could be met for all hospitals. In the case of Mallow General Hospital and other hospitals, whatever is safe to take place there will take place there.

We must meet a new licensing and accreditation regime for acute hospital services, probably by 2011. If we were to introduce that licensing arrangement now and if we had the legislation, many of the services would not be licensed by any competent or objective authority because they do not meet the quality and standards of care that people are entitled to expect. Therefore, the configuration has very much been driven by patient quality and safety. I believe Professor Higgins has the capacity and vision to win the clinical support of the doctors in Mallow General Hospital. The engagement has begun, but I am unsure whether it has begun in Mallow. However, he has begun to work with his colleagues and I remain optimistic that he will reach agreement on the procedures which should take place there. It is not a matter for me, because I am not a clinician, nor would I be competent to decide.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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Does the Minister not acknowledge that a lack of investment in a day procedures unit, which has been mooted for the past ten years, is the reason those statistics are low? If there had been such investment, Mallow General Hospital would be punching even further above its weight than it does as present.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I hasten to add I am not being critical, because it was placed top of the class along with St. Vincent's Hospital on the hygiene audit. Last year, I visited Mallow General Hospital and I was very impressed. There are infrastructural requirements for the hospital as there are for many acute hospitals. There are a large number of very old hospitals providing services and we must ensure any monies available for the capital plan are used to address safety issues such as those mentioned by the Deputy.

There is also a high level, that is 20%, of "did not attends" at the outpatient unit in Mallow General Hospital. I am examining measures to disincentivise people from not showing. Thousands of outpatient appointments are being lost to other patients because people simply do not attend. We must examine that also.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The House should note that at last week's meeting of the Oireachtas Joint Committee on Health and Children the Minister put on record that she had the authority to halt the closure of hospitals and the removal of acute services from hospitals such as Mallow General Hospital, Monaghan General Hospital, Nenagh General Hospital, Ennis General Hospital and Roscommon County Hospital, to name but five. There will be others too. Has the Minister ever given consideration to the substantial body of work which argues, contrary to her long held view, that centralisation is the best way to proceed, and that strongly contradicts the notion that high volumes means best outcomes in all cases? Has the Minister noted or re-read the York Health Economics review, often cited as one of the key reports supporting the notion of centralisation? Has the Minister taken heed of the fact that in its conclusion the review makes clear that there is no casual link between high volumes and best outcomes?

Does the Minister not accept that, as in Mallow General Hospital and each of the other hospital locations I cited, there is a very strong expression of opposition throughout the range of service providers, both in terms of in-hospital services providers, namely, consultants, doctors and nurses, and the general practitioners within the community, who strongly and vehemently oppose what she proposes to do? This is replicated throughout each of the sites I have instanced. When, if at all, will the Minister listen to the contrary view and give due regard to the opinions of those entrusted with the coal face delivery of acute hospital services at each of these sites, given that the model she proposes to introduce is based on the experiences of other jurisdictions which are now being revisited?

The Minister is taking no cognisance whatsoever of the unique make up of the Irish health care delivery system, especially in respect of acute hospital services. When will she desist in her plan, or will she allow the opportunity for others to revisit the damage that she has already inflicted on the hospital system throughout the State?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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We are not centralising. We are bringing hospitals together to work as a network. The evidence is overwhelming. Every training body has signed on. For example, the Royal College of Surgeons in Ireland strongly supports the cancer control plan. Volume equates with quality. Since the volume in terms of rare diseases is low, this does not apply to all cases, but volume and quality are linked in common conditions.

When the Deputy's party colleague was the Minister for Health, Social Services and Public Safety in Northern Ireland, she adopted the same approach to cancer services. Indeed, the North is far ahead of us. From every meeting that I have attended, Ministers across the EU face the same challenge.

More than 7,000 doctors work in our hospitals, but the manner in which they are organised does not deliver the best results for patients or best practice. Last week, I met the clinical directors appointed under the new consultants' contract. They are enthusiastic about what is occurring at hospital level and the re-organisation of services into teams of doctors. In the mid-west, 12 surgeons will work as a team instead of there being four teams. This makes eminent sense in terms of patients, the use of expertise, critical mass and the other matters about which we are concerned.

A decision to halt matters would be based on politics, not patient safety and outcomes, which must come first. In terms of good patient outcomes, the clinical expertise must be put before political interests. This is what is occurring. There is huge——

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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There is considerable evidence to contradict the Minister's position.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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There is not. There are individual pockets——

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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There is no guarantee of good outcomes in terms of volumes.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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——in which people are perceived to have been adversely affected and might not be happy from time to time. In the main, all of the training bodies support the reform. There may be issues along the edges, but the reform of hospitals is supported.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Within the regulatory——

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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We are almost out of time, but the two Deputies offering can make brief comments. We have given these questions ten minutes.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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The regional hospitals are not getting the additional resources required. The Minister mentioned the considerable successes in the mid-west and the north east, but the people in those areas view them as anything but. People in Drogheda and the rest of the north east are sorely disappointed and disillusioned. I fail to see how a 55-bed acute medicine unit at Monaghan General Hospital will be replaced by a medical assessment unit at Cavan General Hospital.

People can reflect on a modus operandi. A hospital starved of resources consequently starts to engage in unsafe practices and a report commissioned to confirm this fact is used to undermine the hospital further and to close it down.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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Hear, hear.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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What is the Deputy discussing?

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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The process in the mid-west, which will be similar to the services in the south and elsewhere, involves the reduction of accident and emergency units to a 12-hour service, the removal of all surgery bar day surgery through the lack of surgeons available on a 24-hour basis and the events occurring in respect of the medical team. This gradual removal, the first element of which will occur in the mid-west in April, is of concern to people, as the Minister has not committed to making the investment that will be necessary to allow the smaller hospitals to fulfil their important economic and community service roles. Nor will money be invested in tertiary hospitals.

During these times of cutbacks, people are fearful that all of the service reductions will occur, beginning with accident and emergency units and followed by surgery and medical services, but that none of the positives about which the Minister speaks so eloquently will be forthcoming. This is a fear even among those who believe that some of the Minister's proposal is a good idea. With genuine reason, they are concerned that the proposal will be used to reduce services in smaller hospitals without making a return.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I am not aware of the report on a hospital not performing because it had been starved of resources to which Deputy Reilly referred. We have increased resources five fold in the past 12 or so years, but it is not just an issue of resources. Were there never to be an extra penny, the manner in which we organise services does not meet the patient safety test. This issue must be addressed as a matter of urgency.

Regarding the mid-west, people from counties Clare and Tipperary will receive more treatment at their local hospitals than is currently the case through the re-organisation of the services.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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Will the Minister invest the capital and other resources identified in the teamwork report?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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The resources necessary to do what we want this year will be forthcoming. We have already given——

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Will we have our eight accident and emergency consultants and our high dependency units, HDUs?

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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Allow the Minister to conclude, as we have gone over time.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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We are being told dreams.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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Deputy Reilly needs to read the report in its entirety instead of taking pieces from it. The commitment to the——

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Likewise.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy has been briefed by Dr. Paul Burke, Dr. Cathal O'Donnell and many of the region's other clinicians, who are enthusiastic. I am sure that there are doctors in the mid-west who do not agree, but everything has its enemies and reform has quite a few cynics, who we know. However, the majority of hospital doctors in the mid-west are enthusiastic about the changes, including doctors in Clare, Nenagh, St. John's Hospital and Limerick. That is a fact.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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They are not enthusiastic about the manner in which they are being done.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is wrong to use language like "enemies". I said that doctors were——

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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I apologise to my colleagues, but we must move on.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is an outrageous slur and the Minister should withdraw it.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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The Chair has been generous in allowing time for this question, which was in Deputy Sherlock's name. The next questions will be Nos. 40, 101 and 212.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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They relate to another part of the country.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The same story.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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A stock response.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is like the Monaghan template in that it is multi-transferrable.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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The Minister without interruption.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I must repeat the truth.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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Question 40: To ask the Minister for Health and Children her plans for the development of services at Roscommon County Hospital, which will benefit efficiency within the health system; and if she will make a statement on the matter. [13020/09]

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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Question 101: To ask the Minister for Health and Children her plans for the development of services at Portiuncula Hospital, County Galway, which will benefit efficiency within the health system; and if she will make a statement on the matter. [13021/09]

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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Question 212: To ask the Minister for Health and Children when the second general surgeon at Roscommon County Hospital will be appointed on a full-time permanent basis; if this appointment is dependent on funding being made available; and if she will make a statement on the matter. [12817/09]

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 40, 101 and 212 together.

The Government is committed to ensuring the delivery of the best quality health services for the people of County Roscommon in a safe and cost effective way. Ensuring patient safety is paramount so that people can have confidence in the services and that the best possible patient outcomes can be achieved. It is essential that we prioritise patient safety and quality and that we organise and manage services accordingly. The priority is to provide safe services as close as possible to where people live.

In the past, Roscommon County Hospital and Portiuncula Hospital, Ballinasloe, have operated independently, with two consultant general surgeons in each hospital. The difficulties faced by Roscommon and Portiuncula in maintaining surgical services independently and the need for closer co-operation between them were highlighted by the former Comhairle na nOspidéal in March 2006. Advances in clinical care and ever increasing levels of specialisation mean that the present model of care faces important practical difficulties, which must be addressed.

In light of these factors, the best way of retaining and developing services at Roscommon and Portiuncula hospitals is for them to work closely together and with University Hospital Galway. The Health Service Executive has advised that it is proceeding with the proposal for a joint department of surgery and anaesthesia at Roscommon County Hospital and Portiuncula Hospital. There will be five consultant surgeon posts in all with joint services between the two hospitals. The detailed arrangements for the operation of the joint department will be developed in consultation with the consultants involved once all are in place and following a period of operation.

Funding of these posts is not an issue. One of the two consultant surgeon posts at Roscommon is currently filled by a locum, as the permanent postholder is unavailable. The appointment of a permanent consultant surgeon to this post at Roscommon will be considered by the HSE in the context of the establishment of the joint department of surgery and anaesthesia.

Interviews have been held to appoint a third consultant physician at Roscommon County Hospital with a special interest in respiratory medicine, with sessional commitments at Portiuncula Hospital and at University Hospital Galway. A replacement post of consultant physician with a special interest in endocrinology at Roscommon County Hospital, with sessional commitments to Portiuncula Hospital and University Hospital Galway, has also been advertised. I understand that interviews for the post of clinical director at the two hospitals were held last month and that a candidate has been appointed.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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I thank the Minister for her reply, which addresses three of my questions.

On the issue of patient safety, I cannot understand how one can describe as safe for patients the closing down of smaller hospitals and transportation of people to the next available facility, without additional ambulance service resources, in journeys lasting an hour to an hour and a half. This is the fundamental issue that has not been addressed in respect of the hospitals under discussion today.

Why have I received the same standard reply in January, February and March regarding the third consultant physician post and the replacement consultant physician post? Nothing seems to have happened during the first three months of the year. In the context of the current issues regarding capital funding, where now stands the central sterile supplies department? This reverts to the point made by Deputy Reilly regarding starving facilities of resources because unless one's theatres possess basic facilities for sterilising equipment, one will not have a surgery department. Can the Minister guarantee that such investment will be put in place this year? The day surgery spoken of by the Minister cannot take place without such basic investment. On a number of occasions, the Minister has discussed the development of outpatient services at Roscommon County Hospital. Nothing has happened to expand such services even though she has given numerous commitments in this regard. Moreover, the dermatology clinic again is being relocated from Roscommon.

I refer to Roscommon and Portiuncula hospitals. A national review has been completed of critical care facilities. Publication of that review was expected in November last year. Why has such publication not taken place and why is this leading to a lack of investment in respect of the coronary care high-dependency units at the hospitals, which are fundamental to the maintenance and development of both?

Finally, can the Minister explain the reason the special care baby unit at Portiuncula Hospital, Ballinasloe, has not been opened? If the Minister gets the opportunity, she should look at the appalling condition of the current facility there. Although the hospital has a new state-of-the-art facility, there are no resources to staff and man it.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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Two minutes remain in this slot.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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As for the aforementioned consultant appointment, the Deputy is aware there are personnel issues in this regard. I understand the current post-holder has an illness.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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No, I referred to the two physician appointments, namely, the third consultant physician and the second replacement physician. I am familiar with the issue in respect of the surgeon.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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At present, we are in the process of appointing two physicians.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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Yes, but nothing has happened since January. I refer to the stock reply I received over the three months of January, February and March.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I have not been briefed to answer that question and will revert to the Deputy, if that is in order.

As for the sterile unit, it will happen this year. There is a commitment——

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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Is it not dependent on cutbacks taking place?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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No.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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It will go ahead?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I am advised this will happen during 2009.

In respect of many of the issues pertaining to critical care and high dependency, if the hospitals continued to operate separately as two independent hospitals, it would not be possible to deliver the high-quality service that currently is the benchmark. While this may not have been the benchmark in the past, in regard to the answers to earlier questions, we undoubtedly must change the way in which we work to meet the patient safety criteria of today, given the new environment including the presence of HIQA and so on.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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When will the report be published?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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As for the services within Portiuncula, the HealthStat data on Portiuncula were highly disappointing and serious issues must be addressed within that hospital pertaining to a number of issues, including the public-private mix and many other areas that I will not go through here. From henceforth, they will work virtually as a single entity, certainly as far as surgery and other services are concerned. Therefore, these issues must be addressed because there is no point putting more money into services that are not delivered in a cost-effective manner.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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The Minister should answer two of the questions I asked. First, why has the special care baby unit, which is a state-of-the-art facility, not been opened and manned properly? Second, when will the critical care report be published? I refer to the national report.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I do not know the answer regarding the critical care report. As the Deputy is aware, there are serious industrial relation issues in Portiuncula, which are costing an enormous amount of money. That issue is before the industrial relations machinery of the State at present and the sooner it is addressed, the better because of the amount of money that is being wasted. I do not know whether that is the reason.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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No, it is not.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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We have been losing €30,000 on this dispute for quite a long time now.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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It is a resource issue. This is a state-of-the-art facility for very premature babies. This is appalling.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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Briefly, I call on Deputies Reilly and Ó Caoláin. Deputy Reilly must be brief.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I remind the Minister, in respect of her remarks that I should read the full report, that perhaps she might do the same herself in respect of the Teamwork report. She asserted in this House that there would not be the same need for beds, as they were not closing down the maternity and orthopaedic units in Macroom. The beds that were mentioned in the report were in addition to those beds and not instead of them.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I will be brief and refer to two statements, the first of which states:

The latest . . . attempt by the Western Health Services Executive to remove in-patients surgery and to downgrade the services at the Roscommon County Hospital is in direct conflict with stated Government policy.

The second states:

Four consultants at Roscommon County Hospital have seen fit to state publically in writing that the Western Health Service Executive proposals are unsafe for patient care and will lead to the loss of life.

The author of both statements is none other than Deputy Finneran, who now is a Minister of State in the current Government arrangement. Why is it that statements such as these that have been made in respect of Monaghan General Hospital have been ignored and yet Roscommon seems to merit a different response? What is the explanation? While I welcome that Roscommon still has the semblance of a hospital at its site, why does the haemorrhage of services continue, to the point at which we are almost at a turn of the key in the door, at Monaghan General Hospital?

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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I thank the Deputy.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister should explain.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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As the Deputy is aware, Monaghan and Cavan will operate as a single hospital.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I thought Roscommon and Portiuncula hospitals were doing——

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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They are a single hospital.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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——something similar?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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Roscommon and Portiuncula hospitals will work much more closely together than was the case in the past.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Why have services been removed from Monaghan?

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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The Deputy should allow the Minister to conclude.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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As the Deputy is fully aware, they were removed for patient safety reasons.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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That concludes——

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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That is absolute nonsense.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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——Question Time for today.