Dáil debates

Wednesday, 30 November 2011

Topical Issue Debate

Hospital Services

4:00 pm

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
Link to this: Individually | In context

St. Joseph's District Hospital, Ballina, County Mayo, a 62-bed hospital, provides step-down facilities for patients discharged from Mayo General Hospital and those identified as requiring a long-stay bed in a community nursing unit. It also provides outpatient clinics such as surgical, medical, paediatric and orthopaedic services.

Staff have been informally informed that there may be substantial bed closures in the hospital in the new year. If these go ahead, the ability of the hospital to perform will be seriously undermined. Mayo General Hospital performs well on the basis of a good relationship with district hospitals in Ballina, Swinford and Belmullet and their capacity to deal with step-down facilities. Its performance is in direct contrast to that of the regional hospital, University College Hospital, Galway, where bed management issues are serious.

Up to 60 beds have been closed in Dalton community nursing unit, Claremorris, Áras Deirbhile, Belmullet, McBride community unit, Westport, and at St. Augustine's, the other community nursing unit in Ballina. There is a concern in the county that services for the elderly are being downgraded and people will be forced into the private nursing home market.

Due to a large number of retirements that will occur in the health services, management has proposed a temporary closure of the facilities in St. Joseph's District Hospital. We all know what a temporary closure is in HSE language. Deputy Keaveney referred to €61 million being owed to HSE West. We have raised the matter of this deficit at local fora meetings. One of the reasons given by management for the deficit is that forms consultants should fill out are not being filled out and forwarded to private health insurers. I do not have a difficulty with what they are paid for the job they do but if they are responsible for a €61million debt due to the HSE, which, in turn, may be responsible for the downgrading of services for older people across Mayo, then there is something wrong with the system.

I would like the Minister of State to visit the hospital. Her predecessor with day-to-day with responsibility for the primary care strategy had opened a state-of-the-art primary care centre and she will find no better alcohol addiction centre in the country than Hope House in Foxford. The staff and management are angels for the work they do. However, if our hospital is undermined, this will not be the first time I raise the issue in the House. It has served my town for generations and I would like that to continue.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Labour)
Link to this: Individually | In context

I thank the Deputy for raising this matter.

Intrinsic to the Government policy of keeping older people at home and in their communities is that we enable them to access quality short-term care. This option also alleviates pressure on acute hospitals by providing an alternative to admissions or lengthy stays. It makes sense from the patient's point of view and from an economic point of view. The programme for Government includes specific provision under capital developments in health for step-down facilities. Our intention is that people are cared for in the most appropriate and cost effective setting, including short-term care.

The HSE has sole operational responsibility for the delivery of health and social services, including those at facilities such as St. Joseph's District Hospital, Ballina. The Department is reviewing the provision of public residential care in light of the need to meet national standards and regulations, local demographic pressures and public and private provision. The review will serve as a platform for discussion and will inform the development of an overall strategy on how the HSE should continue to provide this service in future in view of current budgetary and other pressures. The review must also be seen in the light of the wider health reform programme to which the Government is committed, and the position of social care services in a future health service.

St. Joseph's District Hospital currently has 62 beds, of which 25 are designated for female patients and 37 for male patients. The facility mainly provides semi-acute step-down care and also accepts admissions directly from general practitioners in its catchment area. During 2010, there were 741 admissions, of which 500 were transfers from Mayo General Hospital and other acute hospitals. The stay at the hospital is 24 days. The total staff complement is 60 whole-time equivalents, of which 30 are nurses and 22 are support staff. Between January 2011 and February 2012, it is expected that eight vacancies will arise due to retirement.

Detailed discussions have taken place between management and the director of nursing to determine the number of patients that can be safely cared for with reduced staffing levels on the roster. It is anticipated that, in the circumstances, the HSE proposes at this stage to reduce the number of beds at the hospital by 12, from 62 to 50. I understand that staff have been informed of this proposal and that further meetings between management and staff representatives will be arranged, as necessary. The expected position regarding bed provision will apply from a current date, yet to be decided, to the end of January 2012, at which time the matter will be reviewed, as appropriate.

The main objective of the HSE is to maintain the maximum number of beds in line with staff resources available. The Deputy will appreciate that all developments have to be addressed in the light of current economic and budgetary pressures overall. Decisions taken by the executive must have regard to this, including the current moratorium on the recruitment of nursing and non-nursing staff. The executive has been asked, in this context, to make a rigorous examination of how existing funding might be reallocated to ensure maximum service provision. In particular, we need to ensure the highest standard of care will continue to be provided to all patients in a safe and secure environment, including to those at St. Joseph's.

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
Link to this: Individually | In context

With the closure of an additional 12 beds in Ballina together with the closure of 60 beds that has previously been announced, a total of 72 beds will be closed in homes and community care facilities in County Mayo. I do not know whether the Minister of State fully understands the geography of the county, which is the third largest in the State. The facilities are arranged in a way to provide services. Unfortunately, many people cannot be cared for in their homes and they need the services delivered by staff who go beyond the call of duty every day.

Will there be further reductions in Ballina? At the end of January, what are the chances of these beds being restored or will there be further closures? With regard to the information provided by Deputy Keaveney earlier, how much is due from health insurance companies? In fairness to the HSE, much of the debt is outstanding for less than a year and, therefore, staff seem to be getting their act together. It would be outrageous if beds for older people, no matter where they are in this country, were being closed because the HSE did not have the ability to get consultants to fill out forms properly. A total of €61 million is outstanding in HSE West, which is one of the smaller districts. Surely heads can be knocked together among HSE staff, insurance companies and consultants to return the money that is owing rather than closing beds in St. Joseph's or elsewhere in the community and nursing home sector in County Mayo.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Labour)
Link to this: Individually | In context

A considerable number of patients in acute hospitals need more appropriate care and it makes sense to provide care and step-down facilities as locally as possible to ensure older people, in particular, who spend short spells in acute hospital have access to the rehabilitation required for them to make a full recovery and live independently in their own homes, which is what the vast majority of them want.

A number of issues have to be taken into consideration. The model of care provision needs to be reconsidered while the cost of care in private settings and, last but not least, the quality standards required by HIQA must be taken into account. These will all be factors in the review of the services provided in step-down facilities over the coming months.

A substantial amount is owed to the HSE by acute hospitals because consultants who are exceptionally well paid have not filled out the necessary forms. It is unacceptable that they are required to fill out those forms in order that hospitals can access the payment from the insurance companies. These two requirements need to be decoupled and consideration is being given to that. It is also not acceptable that consultants have failed to do their duty and comply with the requirement to fill out the forms. This means substantial debts are owing and the HSE is faced with difficult decisions. The executive needs to be much more proactive in this regard, as I stated in reply to Deputy Keaveney. It is not acceptable that the HSE should leave an outstanding debt while imposing cuts on the most vulnerable. It needs to tackle this issue as a matter of urgency. I agree with the issues raised by the Deputy.