Tuesday, 14 December 2010
I thank the Ceann Comhairle for giving me and Deputies Breen and Dooley the opportunity to raise this important issue.
As late as last May at a Western Regional Health Forum meeting, the HSE stated that there was to be no change to the services currently offered at Ennis General Hospital. The re-organisation of acute services in the mid-west came about as a result of both the Teamwork and the Health Information and Quality Authority, HIQA, reports into the breast cancer misdiagnoses of the late Ms Ann Moriarty and the late Ms Edel Kelly. At the launch of the HIQA report, Dr. Alan McKinney, a member of the HIQA Ennis investigation team, stated: "Before transferring a hospital service, it must be ensured there is a safer, better alternative available. There is no point making things worse than they are now". However, hospital services are being closed on the cheap without adequate resources being provided in the major centres or so-called centres of excellence, in this case in Limerick. This questionable practice presents us with the dangerous scenario of ultimately ending up with nothing at both county and regional level and endangering the patient, according to Dr. McKinney's hypothesis.
What has the Minister done about the major capital works outlined in the Teamwork report with regard to Limerick Regional Hospital? She has done very little. Why are there regularly up to 50 patients on trolleys in Limerick Regional Hospital? Why must patients wait for months for MRI scans in that hospital? Where is the better cardiac service for Limerick? Is there a 24-hour emergence cath lab service in Limerick Regional Hospital? There is not. Why strip the service in County Clare and replace it with nothing?
Prior to accident and emergency services reconfiguration in April 2009, I vividly recall the Minister for Health and Children and the HSE ploughing ahead with their strategy without even putting in place a proper ambulance service for the people of County Clare. They were happy to pursue this course until Dr. Paul Burke appeared on a "Prime Time Investigates" programme and outlined the reality. That is the level of commitment displayed to date - try to do things on the cheap, unless one is questioned.
The reconfiguration process has been ongoing for more than 18 months. It is time to have an independent evaluation of the process.
I am asking that HIQA officials be called in to evaluate where we are on reconfiguration. Has the Government delivered on patient care? I do not think it has. It has delivered on saving money, but it has not delivered on the patients.
I also wish to thank the Ceann Comhairle for facilitating the Clare Deputies in what is an important issue for us. I welcome the opportunity to contribute to this debate tonight. Concern has been raised with me and other public representatives in the past number of days regarding the possible downgrading of cardiac services at Ennis General Hospital. As the Minister of State here tonight is aware, Ennis General Hospital has seen significant change in services provided in recent years. It has been always based on patient safety and the quality assured service that should be delivered at any particular time. The core of this whole reconfiguration process has been the necessity to ensure the service is quality assured and is in the best interests of the patient.
The transfer of acute surgery to the Mid-Western Regional Hospital in Limerick was brought about by a number of misdiagnosed cases at Ennis that had tragic outcomes for patient safety and the quality of the service. All of us have recognised the importance of that. However, as part of that reconfiguration process, it had been always recognised that many services could be delivered at Ennis General Hospital in the best interests of patients and in a safe environment. In particular, it was recognised that Ennis would play an important role in the delivery of medical services, and that included some acute services. In my view, cardiology is one such medical service that can and should remain at Ennis. Nobody has put forward to me any case for moving the service.
I accept that interventional cardiology is by necessity delivered at a hospital such as the Mid-Western Regional Hospital in Limerick, where CAT labs and other enhanced technologies are available to provide that service. However, I see no reason the current service in Ennis should be in any way diminished or removed. It does not make sense from a cost point of view, from a patient safety point of view, or from any other point of view.
The Minister for Health and Children met with me and the Minister for Defence this evening. She gave us a fair hearing. She allowed us to put forward a very strong case for the retention of the service, and she recognised the necessity to continue to build on the services that are delivered in Ennis, so that the reconfiguration process can continue. It will not be possible for Limerick to manage the entire services of the region. It is just not physically possible to do it, and it is important that services are maintained in both Ennis and Nenagh, and enhanced rather than reduced. I look forward to what the Minister has to say this evening, given that she has had the opportunity to hear the three Clare Deputies this evening, and more particularly, given that she had a face to face meeting with the Minister for Defence and myself where we put forward the case on behalf of the people we all represent.
I welcome the opportunity to speak tonight on this important issue for County Clare. We all know that when the Government made the decision to reconfigure services to the Mid-Western Regional Hospital in Limerick, it signed the death warrant for the future of Ennis General Hospital as an acute medical hospital. I am delighted to see Deputy Dooley raise his concerns tonight, like the two of us on this side of the House. When the €14 million upgrading work started in the hospital earlier this year, I recall reading Deputy Dooley in the newspaper saying it was a vote of confidence for the retention of Ennis as an acute medical hospital. How could that be so? Ennis has been stripped of acute surgery. The 24 hour acute accident and emergency service is gone, as is intensive care. We are told that on 1 February, the cardiac services, including the high-dependency unit, will be transferred to the Mid-Western Regional Hospital as part of the HSE's plan to centralise cardiac services.
It is very easy to forget the €30 million promised by the former Taoiseach, Deputy Bertie Ahern, when he breezed into County Clare during the general election campaign in 2007. What happened the other €25 million? Did it disappear into a black hole?
The transfer of cardiology services was contained in the small print of the HSE's action plan for acute and community health services published in 2008 and supported by the Government. However, this was not supposed to happen until facilities at the Mid-Western Regional Hospital were put into place. This clearly has not happened. The sod has only just been turned on the new critical care unit. The CAT scan laboratory, which was supposed to operate at the hospital on a 24 hour basis, is operating from 9.00 a.m. to 5.00 p.m only. Clearly, the logic for centralising cardiac services depends very much on this system being put in place, so that a CAT scan can be read within two hours. Those of us who visit the Mid-Western Regional Hospital in Limerick can see it is like a building site at the moment, and there is a very serious shortage of parking spaces there. There is also a huge shortage of beds and severe crowding in the accident and emergency department. This evening, there were 24 patients waiting on trolleys in Limerick, while there were nine patients waiting in Ennis this afternoon. The ambulance personnel are doing an excellent job, but they will not be able to cope when this change comes into place without being given additional personnel and resources. They are already overstretched.
I understand that 1 February is the date set for the transfer of these services. The Minister for Defence, Deputy Killeen, and Deputy Dooley had a meeting this evening with the Minister for Health and Children. It looks like that may be put on hold until after the general election. Maybe that is being done so as not to hurt the Government Deputies in the constituency.
When will the 24 hour CAT scan laboratory be put in place at the Mid-Western Regional Hospital in Limerick? Galway already has the facility. What plans has the Minister in place for Ennis General Hospital? What is the future of inpatient services at the hospital? Will it be just a day surgical hospital? I fear that when the cardiac services at Ennis General Hospital are transferred to Limerick, it will be the nail in the coffin for acute services at Ennis. We want these questions answered tonight in the interests of patient safety, as we are all concerned about that in County Clare.
John Moloney (Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Justice, Equality and Law Reform; Laois-Offaly, Fianna Fail)
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I am taking this Adjournment debate on behalf of the Minister for Health and Children.
Patient safety is central to the delivery of health services. People must have confidence in the care they receive and have the best possible outcomes. The way in which we deliver acute hospital services to our communities and their wider regions is changing.
The HSE has made significant progress in re-organising acute hospital and related services in the mid-west region since April 2009. While this has involved the relocation of some more complex services to the Mid-Western Regional Hospital at Dooradoyle, in the interests of patient safety and quality, Ennis General Hospital, as part of the regional hospital network, now undertakes an expanded range of day case surgery and diagnostic work. The Minister is anxious that the range of such services provided in Ennis General Hospital should continue to be expanded, so that people can have most of their health care needs met as close as possible to where they live.
All the cardiology services currently available in Ennis General Hospital will continue. The future of these services at Ennis General Hospital is secure and they will continue to be provided by a specialist cardiology team. In fact, these services will be expanded further, with the addition of cardiac failure clinics and cardiac rehabilitation services for patients who have had the acute phase of their illness managed in the Mid-Western Regional Hospital in Limerick.
In deciding on the best model for the provision of cardiac services in the region, the unanimous medical advice is to centralise acute cardiology to the Mid-Western Regional Hospital in Limerick. This is in line with the model being developed in the region, whereby services are organised on an integrated regional basis, delivered in a range of locations and settings. To facilitate this, a fourth cardiologist is being appointed. This will facilitate a separate cardiology rota, giving patients access to a cardiologist on a 24-hour basis for emergency cases in the region.
Interventional cardiology will be performed in the designated cardiac catheterisation laboratory in the Mid-Western Regional Hospital in Limerick, thereby enabling patients to receive the best possible care in the event of an acute cardiac episode. Six additional inpatient cardiology beds will be designated in the Mid-Western Regional Hospital to support this service. These developments will be brought on stream in the course of 2011, after the fourth cardiologist has taken up duty. General medical services will continue to be provided at Ennis, and the majority of medical patients, including respiratory patients, will continue to be treated at the hospital.
Ennis General Hospital has recently been a recipient of significant investment, with the installation of a CT scanner at a cost of €900,000, which became operational in 2009. In addition, an endoscopy suite for day medical procedures, at a total cost of €2.5 million, is under construction and is due to be completed by April 2011. The HSE has received planning permission for a new ward block containing 50 replacement beds. It is estimated that the construction of these facilities, which will cost €8 million, will be completed by the end of 2011.
The Minister and the HSE recognise the importance of Ennis General Hospital and the contribution it has made and will continue to make to the provision of hospital services in the region. Ennis General Hospital is a pivotal component in the provision of acute services in the mid-west. I assure the House on the Minister's behalf that there will be no reduction in the level of cardiology services provided at Ennis General Hospital and that it will continue to play an important role in the provision of health services to the population of the mid-west region.