Dáil debates

Wednesday, 10 November 2010

8:00 pm

Photo of Willie PenroseWillie Penrose (Longford-Westmeath, Labour)
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I sincerely thank the Ceann Comhairle for facilitating me in permitting me to raise the ongoing situation at the Midland Regional Hospital in Mullingar. Regretfully, I have to raise it again, particularly the decision to suspend elective procedures at the Longford-Westmeath regional hospital in Mullingar, which is extremely important in terms of its location for the citizens of Longford and Westmeath and as a central and pivotal hospital for that region. Theatres at the hospital will be only staffed with cover for obstetrics for a further three month period for emergencies and for children.

These measures were recently announced at the hospital but, as in the case of many matters concerning the HSE, it is difficult to extract information from it. These measures clearly led to reduced activity at this important, progressive and most efficient hospital. It is one of the most efficient hospitals in the country in terms of all the parameters, output data and casemix assessment that are now used to determine degrees of efficiency and effectiveness.

I raised the issue of the severe bed shortage that has led to record numbers of patients being placed on trolleys in the accident and emergency department of the hospital. In the last few days of October, in excess of 130 patients were on trolleys. This is the position at one of the busiest hospitals and most efficient accident and emergency departments in the country and it arises because up to five wards have been closed in the hospital.

In October 2007, there were only four patients on trolleys; in October 2008, there were 11; in October 2009, there were 70; and in October 2010, there were 132, which represents a 3,200% increase compared to 2007. The number of patients who were on trolleys up to the end of October 2010 was 1,620, which represents a 392% increase compared to the same period in 2009. In the first four days of November, 24 patients have been on trolleys in the hospital.

Staff in the accident and emergency department are working to the very limits of their capacities and endeavours. They are at breaking point and are deeply concerned as they are expected to care for the ever increasing numbers of patients arriving in this department. I am not surprised at the fact that this situation has now arisen at the hospital, as I predicted this would inevitably arise when 41 inpatient beds were removed from the hospital almost two years ago. This has given rise to significant overcrowding in the accident and emergency department in this context. I am talking about the second most efficient hospital in the country in terms of effectiveness, outputs, casemix assessment and other assessment factors.

In recent days management in the hospital made a decision, as far as I can ascertain, to suspend elective procedures and the operating theatres will be only staffed to a level to facilitate obstetrics and emergency cover, scopes and cover for children; in other words, all elective adult surgery will be suspended with only seven of the 18 staff being utilised. As a result, they will be only able to effectively operate one of the theatres and facilitate emergencies as I outlined.

We are lucky to have an excellent surgical staff comprising nurses, anaesthetics, surgeons and all the other ancillary staff in this hospital, yet routine adult surgery which these people so effectively perform has now been put on hold. I understand that these wards were closed for a specified period but it now appears that it will be extended, although it is somewhat difficult to ascertain the precise intentions of the HSE as it has the happy knack of being extremely vague as to its intentions when it is questioned. As I understand it, even the trade union representatives have still to be fully informed in respect of these issues.

It is abundantly clear that in respect of a person's health, early investigation and detection is extremely important and that, once a person is diagnosed, early treatment would follow. Thus, it is important that elective procedures take place as quickly as possible after diagnosis. If what I have been informed in regard to elective procedures at Mullingar hospital takes place, all that will happen is that waiting lists will build up and grow longer and people will suffer unnecessarily.

The perception locally is that the hospital is being penalised for its great efficiency. It has been too good, as one nurse said to me. People are concerned that what starts off as temporary measures can be elevated to the status of being permanent after a short period. We want a guarantee that this is not the intention of HSE and that it has no plans to downgrade the important facility of the Midland Regional Hospital for the citizens of Longford and Westmeath.

9:00 pm

Photo of Michael FinneranMichael Finneran (Roscommon-South Leitrim, Fianna Fail)
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I am replying to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The Midland Regional Hospital in Mullingar is part of the Dublin-Midlands Hospital Group. The aim of the hospital is to deliver a quality-driven people-centred service to the public of the Dublin-midlands area and, in particular, the Longford-Westmeath area. The hospital at Mullingar operates on a 24 hour, seven day week basis.

The HSE advised the Minister that at the end of September the hospital was 7.2% ahead of its service plan target. The primary drivers for the increased activity in the hospital are in the areas of obstetrics, paediatrics and general medicine, all of which are predominately emergency service driven. In addition, the hospital has provided for 4,784 surgical inpatient and day-case discharges to the end of September, which again exceeds its service plan target. The hospital is currently meeting its target under HealthStat with regard to waiting lists.

The September financial figures showed an increase in expenditure trend for the first time since May. Having regard to the activity to date when compared to the service plan, the HSE decided to review the level of activity that could be facilitated at the hospital for the remainder of the year.

For the hospital to be able to manage its activity it must examine areas of elective work, in particular the area of general surgery.

Following consultation with relevant stakeholders it was agreed to concentrate on emergency surgical activity and urgent elective activity for the remainder of the year. These areas of service will continue to be provided. Any issue or concern about what would come under the definition of emergency activity and urgent elective activity will be dealt with by the clinical director. The HSE has advised the Minister that all caesarean section activity will be facilitated, as will endoscopy procedures.

This arrangement will reduce overtime and agency costs and assist with bringing the budget of the hospital back in line, while delivering on the services promised in the hospital's service plan. The Minister has asked the HSE to keep the issue of service delivery at the hospital under ongoing review in order that patients who require treatment can receive it as quickly as possible in the appropriate health care setting.