Thursday, 11 November 2010
Health Service Investigations
I welcome the Hayes report into the management of radiology and GP referral letters at Tallaght hospital, which was published on 4 November. The report is thorough and clear in its conclusions.
The Tallaght hospital review identified serious concerns about the robustness of the governance structures at board and management level within the hospital. The particular problems with the board and management structure, culture and style must be addressed urgently. The report also points to the inadequacy of reporting systems; the lack of clear lines of responsibility; inadequate risk management; lack of written protocols and procedures; communications within the hospital and with the main stakeholders; and poorly developed relationships with GPs in the area. All of these problems are clearly inconsistent with a patient-centred approach. The report makes detailed constructive recommendations about the operation of specific services in the hospital and all of these will be implemented.
Tallaght hospital has 600 beds and employs nearly 3,000 staff. It operates on a budget of €245 million, of which €189 million is provided by the State. Within this resource allocation, the hospital should be able to provide patients with a safe and comprehensive service.
I met Dr. Hayes on 8 November to discuss the implications of his report and I met the chair of Tallaght hospital on 9 November. I have also had discussions with the CEO of the HSE about the report. The main focus will be on the initiatives that are needed in the hospital and in the wider health system to provide sustained improvements in services for patients. The HSE and Tallaght Hospital have accepted all the recommendations in the report and are committed to implementing them as quickly as possible. A number of key recommendations regarding the management of X-rays and GP referral letters have already been implemented. I understand changes have also been made by Tallaght Hospital to the operation of its board, which I mentioned earlier.
I welcome the Hayes report on Tallaght Hospital. I urge the full and early implementation of all the recommendations in the report. Tallaght Hospital is a fine hospital. Its staff and patients deserve full support. While I acknowledge that progress is being made in addressing administration and filing deficiencies, I must refer again to the cutbacks the Minister has signalled for 2011. What impact does the Minister expect those cutbacks to have on X-rays and GP referrals? How can a significant increase in the amount of time people have to wait to secure treatments be avoided?
This is a real concern not only in Tallaght but in all hospital sites at this time. The Minister has said we have a challenging time ahead. The reality is that it will be a serious time, or worse, in the lives of the many patients who present themselves at our hospitals.
It is clear that when next year's reductions are being made, the priority will be to maintain services for patients. I will deal with that in my discussions with the HSE when I am aware of what the exact figure will be.
The HSE procures €3.2 billion worth of goods and services each year. I want that figure to be reduced in line with what is happening in the economy. In addition, almost €2 billion is spent on drugs. A further €1 billion is spent on non-core pay, such as premium, overtime and on-call pay. The bulk of the reductions need to be found in that basket so that services to the public are not adversely affected. There is a major job to be done in Tallaght Hospital to address the deficiencies that have been identified in this report; in the PricewaterhouseCoopers report, which the hospital commissioned; and in the Teamwork report. The recommendations in the various reports that have examined the operation of Tallaght Hospital need to be implemented as soon as possible. I have received a commitment from the chairman that that will happen.
Yesterday, there were 32 people lying on trolleys in Tallaght Hospital. If the Chair will indulge me, I would like to correct something I said on the record last week. I mentioned that a Government backbencher was given an appointment date for a CT scan that is 13 months away. In fact, he was given an appointment date that is four and a half months away for a simple X-ray. I should have said he has several constituents who are waiting 13 and a half months for CT scans. I would like to raise an aspect of the workings of Tallaght Hospital with the Minister. Does she intend to put any particular structures in place? Has she identified the problems that have led to such a high turnover of CEOs? Can she assure the House that the matter is under-----
I am not an expert in this area. It seems from the various reflections and reports we have been given since Tallaght Hospital was established, particularly the Hayes report, that insufficient homework was done in advance of the merging into one big entity of three small hospitals that had very different perspectives. When one goes into Tallaght Hospital, one will see evidence of the involvement of the Adelaide Foundation, the Meath Foundation and the Children's Foundation. We have to learn lessons from that. That is why so much work is being done in advance of the development of the new children's hospital. We are trying to tease out some of these issues.
Since the publication of the Hayes report, has the Minister had any direct engagement with the management at Tallaght Hospital on the potential for the full implementation of the report's recommendations? I appealed earlier for the deficiencies identified at Tallaght to be rectified at the earliest opportunity. Can the Minister indicate what steps she has taken to ensure the recommendations will be implemented in full at the earliest opportunity?
In the first instance, I have spoken to Dr. Hayes. I have read his report. It is always important to speak to the authors of these reports. I did not meet him until he completed his report because I did not think it would be appropriate for me to do so. He did not ask to meet me. I had a long meeting with him on Monday. I got his insights, in addition to what he had said in the report. I met the chairman on Tuesday morning, with Mr. William McKee, who has come from Northern Ireland at the behest of the chairman and the board to assist the new acting manager, Mr. O'Connell, in the implementation of the key recommendations. I have every confidence that the chairman, Mr. McCann, and the board of the hospital are taking this matter seriously and will put into effect the recommendations in the Hayes report and the other changes that are needed if there is to be a modern and functioning hospital in the south-west part of Dublin. I have every confidence that that will happen.