Dáil debates

Wednesday, 13 October 2010

9:00 pm

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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I wish to share time with Deputy Ciarán Lynch.

Photo of Jack WallJack Wall (Kildare South, Labour)
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Is that agreed? Agreed.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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A prosthetic clinic has been operating in St. Mary's Orthopaedic Hospital, Cork, for the past 21 years. I have testimony after testimony from patients, their parents and four plastic surgeons attesting to the quality, speed and delivery of services at this clinic. One of its patients recently participated and won a medal at the Paralympic Games. Her prosthesis was admired by other athletes for its flexibility and quality. The clinic in question deals mainly with children who have lost a limb, usually a leg, through meningitis or congenital deformity for example. The clinic has ensured they have a service second to none.

The clinic, however, is about to become defunct. I must declare an interest. The National Rehabilitation Hospital was extraordinarily good to me when I had to attend it and no one would deny it provides an excellent service. However, recently its consultant rehabilitation medical clinical director sent a letter to St. Mary's Orthopaedic Hospital stating that because the manufacture of prosthesis is not regulated, the clinic must be shut down and a new supplier put in place, Ability Matters, an English company with clinics in other parts of the country. When I checked its website, it appeared to deal mainly with aids for the elderly. While I do not doubt the company does a good job, in this case the provider does not know the children in question.

There also seems to be a large move towards centralising services. For the past five years I have been seeking the roll-out of the National Rehabilitation Hospital's services in the Cork area. What Cork does not need is a new provider of prostheses. A female doctor in a report on prosthetic clinical delivery in 1998 for the then Southern Health Board stated St. Mary's Orthopaedic Hospital was much more satisfactory on all counts with a strong emphasis on the humane aspects of service provision related to the economic support and information. The report further stated the average cost of a prosthesis per patient at the National Rehabilitation Hospital was 16% higher than at St. Mary's hospital.

The director of the Cork clinic told me of fitting the first limbs for a girl when she was a year old. She still returns to him at 21. This shows how some of the patients have developed with the clinic. One mother informed me how the clinic has no waiting list for children. If a child requires a prosthesis, it is made at the clinic. If it needs adjustment, as a result of growth, or a repair, it will be done on the same day. One cannot tell a child who outgrows his or her prosthesis that he or she will not get one for another six months. Instead, they would be condemned to a wheelchair and immobility. Moving this clinic makes no sense and should be stopped.

Photo of Ciarán LynchCiarán Lynch (Cork South Central, Labour)
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This service has been in Cork for more than 20 years with a proven and exemplary record in providing prosthetic services. There are two essential elements to prosthetic services. First, there is the measuring and fitting of the limb. Second, there is the provision of aftercare and support services required by patients. There are concerns among users of this service as to what will happen to them in the future. Many of them are asking why should a service that works so well be dismantled by the HSE and the National Rehabilitation Hospital while a lesser service is put in its place. This is a local service meeting local needs that has built up a wealth of experience in the past 20 years. Deputy Kathleen Lynch attested to this with her example of the young woman who grew up with the service.

Were studies carried out into the costs of moving this service and, more importantly, its impact on patient care? People are really worried about this. People who have had limbs fitted and are getting aftercare, support and adjustments are now asking who will provide the aftercare and adjustment services if there is a change of company? It is a critical question which the Minister needs to answer. We could have a situation where people who have had limbs fitted in the past 12 months or two years now find that they will have to have their limbs refitted because the new company is coming into operation which will not deal with patients who had their limbs fitted by another company.

Photo of Martin ManserghMartin Mansergh (Tipperary South, Fianna Fail)
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I am replying to this Adjournment matter on behalf of my colleague, the Minister, Deputy Mary Harney. Prosthetics services in Cork currently involve a number of private service providers working out of St. Mary's Orthopaedic Hospital, St. Finbarr's Hospital and North Valley Business Centre, Blackpool, and the National Rehabilitation Hospital, which provides a service on the St. Finbarr's Hospital campus. The service currently operating from St. Mary's Orthopaedic Hospital campus is one of a number of services to which the HSE has been referring a number of its patients over the years. I wish to assure the House that the HSE has no plans to change the arrangements whereby public patients can access this service.

The HSE is, however, planning to move the prosthetics services currently based at St. Finbarr's Hospital. The premises being used for this service are no longer fit for purpose and the HSE is satisfied that the interests of the users of the service will best be served by relocating the current National Rehabilitation Hospital-delivered and HSE-sponsored amputee clinic from St. Finbarr's Hospital to a purpose-built facility at the Mercy University Hospital, Cork.

Amputee rehabilitation is specialist rehabilitation and needs to be done under the care of a consultant in rehabilitation medicine. The HSE's aim is to ensure that a comprehensive rehabilitation service is available to persons who have had or will have an amputation. The service which will operate from the Mercy University Hospital will be a consultant-led service, subject to all the tenets of good clinical governance and best practice. The necessary specialist technical staff will be available on a daily basis and a consultant in rehabilitation medicine with a sub-specialty interest in the rehabilitation of amputees will provide a service on a weekly basis. This represents a substantial upgrading from the service levels currently available at St. Finbarr's. It will be open to patients currently attending the service at St. Mary's to switch their attendance to the new Mercy service, if they so wish.

The consultations on the new facilities at the Mercy Hospital were undertaken at every stage of planning and development. This included meetings with representatives of Amputee Ireland. These initiatives demonstrate the HSE's commitment to improving the provision of this important rehabilitation and ongoing care services for people who have undergone an amputation or who have otherwise suffered the loss of a limb.