Dáil debates

Tuesday, 29 June 2010

10:00 am

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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In the eyes of people living in County Louth, particularly in Dundalk, the closure of the emergency department in Louth County Hospital, Dundalk will have adverse effects. This decision will increase their worries and concerns, especially regarding the 24,000 people per annum admitted to the emergency department in Dundalk who must now go to Drogheda. I understand half of the hospital's 48,000 admissions will now go to Drogheda. The real concern is for those who might have a heart attack and be in extremis. The care they get at present will be physically taken from them in terms of the hospital environment of Dundalk. How can this be better for them? The care they get in Louth County Hospital will no longer be available to them. They are worried because of the time it will take to reach the hospital in Dundalk and thence to Drogheda. People who live in Carlingford or Omeath, for example, live approximately 61 km from Drogheda. On average it takes up to an hour to get to Drogheda. One may have a serious illness, specifically requiring immediate and urgent attention, and may suffer trauma, especially if a heart attack or a stroke are in question.

I understand the Minister for Health and Children, Deputy Harney, is to add an extra ambulance in the area. There will be more ambulances to bring people to Drogheda but those ambulances will have to travel longer distances. The concern is that a greater specialty would be available in Dundalk, greater than what the Minister proposes. I ask her to look at this issue again. I understand there can be specially trained paramedics who could adminster on-site specialist care in Dundalk in extreme cases. That is the real worry for people. Everybody accepts our hospitals have to change and that if one wants to opt into a service and is not a trauma or urgent medical case, it is possible to travel to a different place. However the time concern in this instance is a great worry to people and the fact that people may die on that journey is of concern.

This point was made by 24 doctors who signed a letter in a recent edition of the Dundalk Argus. They stated, "We, as general practitioners and gatekeepers of the health services in the Dundalk area, were ignored in any decision making process". They attended two meetings with their representative and were informed of the intended transformation process. They further stated:

The decision to remove accident and emergency services and acute hospital care was a fait accompli. Our opinion was not considered. We had no influence on the decision making process. The removal of the A & E services and acute medical care will result in increased hardship to the people of north Louth.

Twenty-four local general practitioners signed that letter, expressing professional and medical concern.

Ultimately, we believe Drogheda will struggle to cope with the extra 24,000 patients per annum who will come into the emergency department, notwithstanding the fact that a brand new department opened only last week. The closure of the Louth County emergency department will lead to massive increased pressure on the already strained Our Lady of Lourdes Hospital which has suffered badly from the closure of services in surrounding areas. This has placed increased pressure on the hospital but resources have not been increased in proportion, especially in terms of bed capacity.

People worry about the closure of health services in Dundalk without adequate alternatives being in place. Everybody accepts things must change but now there is a greater worry that people who previously would have been seen in Dundalk by properly trained and skilled emergency doctors and technicians will no longer have that service in place and must travel to Drogheda to get it. I ask the Minister what are the extra reassurances, if any, she can provide at this stage. What especially trained ambulance personnel can she place in situ in Dundalk? I understand that one of the ambulances the Minister proposes to add to the mix will be based in Carrickmacross which is a significant distance away. I reiterate the concerns of people living in north County Louth, especially where there is a topography of mountainous terrain. There is one main road but many of the by-roads are traditional country roads on which it is impossible to make good time. People believe that by the time the seriously ill get to Dundalk they may well have passed on. That is the real worry for people. I ask the Minister to address those issues.

Photo of Mary HarneyMary Harney (Dublin Mid West, Independent)
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I thank Deputy O'Dowd for raising this issue. It is ironic that we are discussing this issue some 90 minutes after discussing patient safety. I assure the Deputy that everything being done in this regard is being done on the basis of the best clinical advice available to me and the HSE. I am conscious there are concerns and worries among the population of north Louth; that is to be expected. However, I am equally aware that the most senior clinicians in this country, led by Dr. Michael Power, who leads for the HSE in regard to critical care and is based in the Mater Hospital, a man with enormous experience and expertise and a leader among his peers, have strongly recommended that this transfer should take place now rather than in the autumn.

As the Deputy is aware, it was intended that this transfer would take place in October, in line with the reconfiguration. The new accident and emergency department has opened in Drogheda and is four times bigger than the previous such department. The minor injuries unit will operate from 9 a.m. until 8.pm. in Drogheda. There is an additional 24 hour seven day week ambulance, to be based in north Louth. When patients are seriously ill and must be taken to a hospital the critical factor is the advanced paramedics who arrive on the site. The Deputy is right to emphasise the significance of the ambulance and paramedic support. In every system throughout the world at which we looked, pre-hospital care and first point of care is often the most significant intervention, especially when a person experiences a heart attack. He or she can be brought to a place and be offered the best possible chance of recovery. We know that some people with heart conditions who reach the appropriate place within two hours and have stenting can effectively reverse a heart attack.

In the first place, the pre-hospital service is important and that has been strengthened in the area. The ambulance service has assured us it is taking measures to strengthen and increase the resources available. Second, there is an additional 24-7 ambulance to be based in north Louth. The ambulance service took the view that the current service in Monaghan should be switched to Carrickmacross to provide better cover for the catchment. In addition, Daisy Hill Hospital will be available. There are protocols for patients to be taken to the hospital if that is appropriate.

Louth County Hospital has a good future. Its future will be in doing different things, such as more elective work and more diagnostics. My colleague, the Minister, Deputy Dermot Ahern, has strongly made the case for a colonoscopy service to be provided there. From 1 January we will be providing a national colorectal screening programme. The Minister, Deputy Ahern, asked that the colonoscopy service for the north east be based in at Louth County Hospital and I strongly support that. I see no reason that we cannot make that happen. I know it is the view of the clinical director, Dr. Ó Branagáin, and through discussions with the cancer control programme, I will ensure that Louth County Hospital is where this service will be provided in the region, rather than at Our Lady of Lourdes Hospital, which will always be under pressure as one of the main hospitals in the north east.

Reconfiguration of hospital services is always challenging and worrying for the public because people become very reassured by having a hospital in their midst. However, we all want the best possible care for members of our families if they are sick. We want them to be taken to the most appropriate place, wherever that is. As they say in the medical world, the right people in the right place at the right time provide the best possible result. The north east has five acute hospitals for a population of 300,000. We are moving into a licensing regime for acute hospitals, probably beginning in 2012 or 2013. The legislation will be published by the end of this year or the start of 2011. We want public consultation on that. The standards that will have to be met by the hospitals will be published next month in draft form by HIQA, and again will be subject to public consultation. These will form the basis of the new law, which has been recommended by most people, including medics, nurses and doctors, as well as the patient safety commission.

At a time when we are talking about licensing kennels and looking after dogs, it is ironic that we still do not have a licensing system for hospitals in this country. It is long overdue and it is going to happen. Everything we are doing is in preparation for that licensing regime. If the system was in operation today, we know that many of the services in some of our hospitals would not be sustainable and would have to be moved.

We are aware of the need to strengthen the ambulance service in the region. In particular, we are aware of the need to make sure that more things are diverted to hospitals such as Louth County Hospital, so that the community will know that the majority of their health needs can be met in the region. It is only when we are acutely ill or have a complex health problem that we will need to go to Drogheda or Cavan. Up to 95% of our health requirements can be dealt with at primary care or in hospitals such as Louth County Hospital.

I thank the Deputy for raising this issue and I assure him we are mindful of the challenges. Change is never easy. I accept what the 24 GPs have said, but I assure him that these decisions are being based on the best clinical evidence available to us. That is not to suggest that the general practitioners do not provide good clinical evidence, but in this case moving critical care and acute care is based on the advice of the experts in that field. This is why it is happening now rather than in October, for when it was originally planned.