Wednesday, 13 July 2011
The cardiac catheterisation laboratory, cath lab, at Waterford Regional Hospital offers patients in the south east vital cardiology services such as coronary angiography, the provision of pacemakers and stents and implanting defibrillators in patients who suffer from a range cardiac conditions. The service has only been operational for three years. Prior to this, patients in the south east had to wait weeks to have these procedures completed in either a Dublin or Cork hospital. These treatments are well advanced. For example, in Dublin a heart attack patient will have a stent inserted into his or her arteries within three hours of presenting in hospital. The cath lab in Waterford may have to return to the old-fashioned treatment of giving clot-busting drugs instead if its times are reduced from five days a week to two, which would be a regressive move. Such a move would also discriminate against patients in the south east because there are no plans to reduce similar services in any other part of the country. Will the Minister for Health stop this move to reduce the laboratory's times which will put patients at risk?
This is one reason the Minister should get rid of the Health Service Executive, HSE, and change health service delivery. Under the old health board structure, health services in the south east were under-resourced. When the HSE was established, it was to ensure patients in every part of the country would have equal access to services. This policy has failed utterly. When it comes to saving money, the HSE goes for the soft option of closing down efficient services in the south east. The cath lab in the south east can be provided at a lower cost but with the same quality of care provided in a similar laboratory in Dublin. Patients in the south east are also entitled to the same access to such a service as patients in any other part of the country. Will the Minister insist on the HSE re-examining where it is reducing health services?
If the cath lab in Waterford is closed, patients will be lying on beds in hospitals in Kilkenny, Clonmel and Wexford waiting to be transferred by ambulance to Dublin. Not only will this lead to a waste of resources in hospitals in the south east but patients will also be put at increased risk of having another cardiac event. A patient not treated in a timely manner will be left with more damage to his or her heart muscle and overall health. The attempt to reduce hours at this cath lab shows the HSE is not fit for purpose. It does not think radically about how it can improve the delivery of services or patient care. It simply closes down services that are easy to close instead of going after overall wastage in the health service.
Has the Minister received a proper reply from the HSE on why this service has been reduced? This provides an opportunity to examine how health services are run. The HSE is closing down services willy-nilly just because it suits it. Government policy is to see money following the patient. We need to pay all hospitals fixed amounts of money to provide services relative to the population size they serve. For example, 500,000 people live in the south east. The cath lab in Waterford should be expected to perform so many procedures a year relative to a population of 500,000. It should, accordingly, be allocated a budget to enable it to do this. Additional payments should be made to hospitals which are more efficient and delivering quality care and low cost services in order that they can undertake more procedures.
Under the current system, hospitals or regions are given lump sums and informed that they should spend these moneys over the course of a year. When they run short of funds, they are told to simply cut services. That represents the worst form of management. I became very annoyed when I discovered that the service to which I refer is to be cut, particularly when people spent years fighting to secure it.
I thank the Deputy for raising this important matter, to which I am replying on behalf of the Minister for Health, Deputy Reilly.
I assure the Deputy that the HSE has no plans to reduce cath lab services from the current level of provision. We all recognise that, in the particularly difficult circumstances the country is facing, hospitals are facing financial challenges in delivering acute services. Waterford Regional Hospital, like all other hospitals, must face these challenges in order to comply with its statutory obligations and remain within its allocated and agreed budget. That is no easy task. Waterford is pivotal to the provision of acute services in the south-east hospital network. Within a budget of almost €133 million and with a staff of over 1,700, the hospital's 2011 service plan sets out targets for the treatment of 23,000 inpatients, almost 20,000 day cases and over 149,000 outpatient attendances.
Waterford Regional Hospital has been achieving savings, through a variety of approaches to obtain better value for money. It is continuing to introduce efficiencies in how it carries out its business. For 2011, there is an increased focus on maximising income collection, a reduction in agency staffing, seasonal bed closures and the elimination of unrostered overtime. Other approaches include reductions in overtime and staff travel and subsistence, better use of generic drugs, more efficient use of locum doctors, using procurement deals negotiated nationally and implementing initiatives introduced under the public service agreement.
Significant investment continues at the hospital. The cardiac catheterisation laboratory - or cath lab - which is the subject of this Adjournment matter, was officially opened last year. Waterford Regional Hospital is now the designated regional cardiology intervention centre for a catchment area of over 460,000 people. HSE south prioritised the development of the cath lab to a five-day service in 2011 because it was recognised that the service needed expansion in order to support all the hospitals in the network. Additional funding of over €1 million has been provided to HSE south - bringing overall funding to almost €2.5 million - so that a five-day service might be provided at the lab. The Minister is pleased to confirm that the capacity of this service will be further developed as resources allow. This will assure Waterford Regional Hospital's role as a major centre for the diagnosis and treatment of cardiac disease.
As with all acute services, it is a matter for the hospital to ensure that the service is delivered in an efficient and effective manner within the agreed budget and in the context of the staff complement provided. The Minister is not aware of any intention to reduce the service from the funded five-day per week model. He welcomes the HSE's plan - details of which have been communicated to the Department of Health - to continue to run the lab on a five-day basis for the remainder of the year in line with its funding and service plan requirements.
I thank the Ceann Comhairle for allowing me to raise this matter. There appears to be a serious problem at St. James's Hospital, which is a centre of excellence for the provision of cancer care. I was contacted by three men in the past couple of weeks who have all been diagnosed with prostate cancer and all of whom require surgery. In the middle of May, one was informed that his surgery would take place in six weeks. Now his procedure has been postponed until the end of July. However, it is not definite that it will be carried at that time. Another of the men to whom I refer was due to go for surgery this week but he has been told to ring on the day before or on the morning on which the procedure is scheduled to take place. This individual has been informed that the procedure may, in fact, be postponed.
The third man by whom I was contacted is awaiting a date but has been told that he should not worry because his cancer is of a type which is slow to develop. The difficulty is that this person has been informed by some individuals that there can be a delay of months in respect of the surgery he requires. He has been told that he should not worry but how can one not worry when one has been diagnosed with cancer and when one requires surgery? That is nonsensical.
As already stated, St. James's Hospital has been designated as a centre of excellence. Patients were diverted from St. Luke's in order to ensure that there would be such a centre and a major argument developed in respect of that matter. If better outcomes are to be achieved, adequate resources must be provided, particularly in acute situations such as that to which I refer.
What is the point in obtaining an early diagnosis if such a diagnosis is not responded to? Everyone will remember the well-publicised controversy which arose a number of years ago in respect of cancer diagnoses. My husband was diagnosed with colon cancer some years ago, a few weeks after I was first elected to the House. He is doing very well now but one of the lessons I learned from what happened to him is that once the surgery was carried out, it was possible for him to adopt a positive mental attitude because he was not focusing on his cancer but rather on his recovery. The men to whom I refer are not being allowed to focus on their recoveries.
There is something seriously wrong when we have designated a centre of excellence and when certain surgeries cannot be carried out there. I telephoned St. James's Hospital and spoke to a nurse in the admissions section of the relevant unit. I felt sorry for her. She informed me that she is on the front line and that every day she is obliged to postpone operations and deal with the people who are continually arriving - by ambulance and by other means - from different places throughout the country. She is completely frustrated. It is not, therefore, just a case of my being informed by the three men to whom I refer that a difficulty exists. A person who works on the front line at the hospital informed me that there is a serious problem there.
I request that the Minister talk to the people who run St. James's Hospital in order that he might be satisfied that the service to which I refer can be provided to those who require it. This matter does not even relate to cutting costs. The longer someone must wait for surgery, the longer he or she is out of work and the longer his or her recovery will take. It is not a question of money, there is something seriously wrong with regard to the way the service in question is being delivered.
I am taking this matter on behalf of my colleague, the Minister for Health, Deputy Reilly. I welcome the opportunity to address the House on the provision of cancer services, including surgery, at St. James's Hospital.
The burden of cancer continues to increase. This year, approximately 24,000 people will be diagnosed with invasive cancer. Each year an average of over 2,600 men are diagnosed with prostate cancer, making it the most common cancer in Irish men other than non-melanoma skin cancer. While approximately 500 men die from the disease each year, it is encouraging to note that estimated five-year relative survival for those diagnosed with prostate cancer in Ireland is now over 89%.
The HSE's national cancer control programme aims to address the challenge of cancer in Ireland. The programme's goals are better cancer prevention, detection and survival through a national service based on evidence and best practice. St. James's Hospital is one of the eight designated cancer centres under the programme. It provides cancer diagnosis, including a rapid-access prostate clinic which is designed to enhance access to early diagnosis and multidisciplinary decision-making, surgery and medical oncology.
Radiation oncology services are now also provided on the St. James's campus in a new unit opened in April 2011. This unit, St. Luke's Hospital and a second new unit on the site of Beaumont Hospital form the St. Luke's radiation oncology network. The development of this network means an overall increase of 50% in radiation oncology capacity over what had previously been available in the eastern region. The new centres reflect the latest advances, equipment and expertise available internationally.
In recent weeks St. James's Hospital has experienced a significant number of patients awaiting discharge to community beds. This means that fewer beds have been available for emergency or elective accommodation and this had knock-on effects in respect of scheduling of elective surgery, including treatment for prostate cancer.
With regard to prostate cancer surgery at the hospital, the national cancer control programme has advised that of the 40 elective urology surgeries booked at the hospital between 1 June and 11 July this year, seven were cancelled. In one instance, the cancellation was due to the fact that the patient did not attend. One of the seven patients affected by the cancellations has already been admitted and treated, while the other six have a date for surgery within the coming three to four weeks. I am pleased to say, on behalf of the Minister, that the hospital now anticipates an improvement in access to prostate surgery as the number of delayed discharges declines.
The latest delayed discharge report already shows a reduction in the number of delayed discharges nationally. The Minister has been advised that the HSE has approved 25 patients for transfer from St. James's Hospital under the nursing homes support scheme since early July. These transfers are now being effected, which will reduce congestion and allow elective prostate cancer surgery to proceed. It is also important to note that St. James's Hospital has confirmed that there is no issue in respect of the resourcing of necessary surgical capacity for these patients or for other cancer patients.