Dáil debates

Tuesday, 22 May 2012

Topical Issue Debate

Hospital Services

5:00 pm

Photo of Eamonn MaloneyEamonn Maloney (Dublin South West, Labour)
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I thank the Ceann Comhairle's office for providing time for the discussion of the recent HIQA report. I wish to reflect on the fact that this report came about following the unfortunate death of Tom Walsh and I join others in conveying my sympathy to his family.

This report is frank, straight and detailed in the 76 recommendations it presents. It commenced as a report on one hospital, namely Tallaght hospital. I have not finished reading it but, interestingly, it raises some important issues about all 33 public hospitals and puts a spotlight on some of the practices and systems that pertain to them.

I note when the report deals initially with Tallaght hospital, it rightly refers to a history of long-standing challenges with regard to governance, management and funding. Every detail of the statement is correct. This begs a question about those supervising public hospitals over the past 12 years and says much about the shortcomings of previous Ministers with responsibility for health and about the HSE. They are as complicit in what happened in Tallaght hospital and what is happening in other public hospitals as those involved in mismanaging hospitals, in this case with regard to governance. This continued for 12 years in the case of Tallaght. I must acknowledge after three months the Minister, Deputy Reilly, told the House he would deal with the issues of governance in Tallaght hospital and he did so. I am not one given to flattering people, but I am stating a fact.

The practices that continued there should not have been allowed to continue but they were. For 12 years the powers that be turned away from what was happening despite the fact that those working in the hospital, the very good staff in Tallaght hospital, were the first to recognise the difficulties and the bad practices in the hospital but got nowhere with those involved in its management and governance and this is regrettable.

When it was first opened, Tallaght hospital was flagged as being the jewel in the crown of the health system. This may have been the intention, but it should be noted the catchment area for Tallaght hospital has a very large population and population growth in the large urban areas in its surroundings such as Clondalkin, Lucan and Rathfarnham was not considered. Therefore, from Tallaght hospital's early days we ended up with it becoming the busiest hospital in the country. Not only was it the busiest but it was underfunded and for its first 12 years neither the HSE nor the previous Minister with responsibility for health did anything about the number of consultants working there. People are mesmerised by the waiting lists and the number of people on trolleys in Tallaght hospital, but there had to be because it had one of the lowest ratios of consultants and operated with one of the largest population concentrations of any public hospital. It could not have gone any other way. It had a pretty unfair deal.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I thank Deputy Maloney for raising this important issue. The recently published HIQA report on Tallaght hospital is a very significant document and I welcome its publication. I am happy to confirm to the House it will be of tangible use as the Government continues to introduce major reforms in the health sector.

Let us not forget what is at the heart of this, that 14 months ago in March of last year a man died in Tallaght hospital. He was positioned on a corridor adjacent to the emergency department and perhaps the most significant single fact is that he was in a corridor where there was not clear clinical responsibility for his care. He was effectively in a zone where no one had clear responsibility for his treatment and he died. At the start of any discussion on this matter I want to express again my deepest sympathy to the family involved. It should never have been allowed to happen and such a tragedy must not be allowed to happen again.

As HIQA states in its report, the corridor was symptomatic of wider governance issues. We should be grateful that HIQA has provided us with detailed analysis of all that flows from this fact. As the Deputy knows, I moved to radically alter the governance of Tallaght hospital last year. This document provides us with a blueprint for many more governance changes that will need to apply on a much wider scale.

I remind Deputies that from the moment the Government came to power I made clear that the problems in our emergency departments would receive the highest priority from me, and in June last year we established the special delivery unit. By September it was operational and much has already been done to tackle the many very complex issues that contribute the problems in emergency departments.

HIQA has recommended that the Department puts in place an oversight committee to implement its recommendations. I intend to put this in place quickly and I will consider immediately how best it should be established.

Many changes have already been made in Tallaght hospital and the report acknowledges this. The practice of leaving patients waiting for admission on trolleys in a corridor adjacent to the emergency department was clinically unsafe and completely unacceptable. As I stated, this has been stopped. The Chief Medical Officer has referred the report to the Medical Council and An Bord Altranais to ask them to address the significant issues that arise.

I have also noted the report's findings into certain financial issues in the hospital. I welcome the involvement of the Office of the Comptroller and Auditor General's into the matter but given the role of the Comptroller and Auditor General, I do not wish to comment further in light of this investigation

Last November, the CEO of HIQA wrote to me with regard to her concerns about the deficits in governance and management at the hospital. As a result a new interim board, chaired by Sir Keith Pearson, was appointed last December. A new CEO is in place who is building a new management team, including clinical leadership.

Safe quality health care is a fundamental principle of the reform programme. Last week, I approved the HIQA national standards for safer better health care to underpin the development of quality safe health care services. The authority will shortly begin providing support to providers to implement the standards.

Long waits on trolleys are unacceptable. The number of admitted patients waiting on trolleys in Tallaght and in 27 other hospitals continues to be proactively managed by the HSE with the support of the special delivery unit in the Department. For the first quarter of this year, the cumulative number of patients waiting on trolleys throughout the entire system was approximately 20% lower than in the corresponding period in 2011. This equates to almost 5,000 patients whose experience of our emergency departments was markedly improved through the work of the special delivery unit. The equivalent result for Tallaght Hospital is an improvement of 63.2%, equating to 1,256 patients.

There are still far too many people waiting for far too long and we continue to address this issue with the co-operation of the clinical programmes and front line staff. I am seeking the greatest collaboration and personal commitment from all involved in the acute hospital system to protect patients and ensure the very best outcomes despite the challenging economic and financial circumstances we face.

Photo of Eamonn MaloneyEamonn Maloney (Dublin South West, Labour)
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I share the Minister's views on the matter and recognise fully the changes he initiated in a very short space of time. I repeat that it is regrettable that the citizens who live in the catchment area of Tallaght hospital had to wait 12 years for these reforms. Tallaght hospital is a better place as a result of the report. I have described it as the busiest hospital in the country. It is fair to state that apart from being the busiest hospital, as a result of recent events it is also the safest public hospital in the country.

I pay due compliment to the very good staff of Tallaght hospital who provide the best possible care within the resources. I wish the new CEO, Eilísh Hardiman, well. She has brought about great changes in a very short period of time and this must be recognised.

I referred to the deficit of consultants at the hospital. Will the Minister clarify what is the appropriate number of consultants for the hospital given its size?

From previous discussions I know the Minister had intended to deal with the issue of the catchment area. Is there a catchment area or is this hospital required to care or cater for such a large number of patients coming from outside its catchment area? Will any changes be introduced so that the hospital can operate within the parameters for which it was built?

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I concur with the Deputy that Tallaght hospital is a much better hospital than it was a year ago. That is very much down to its new management and clinical leadership, and the new board that was put in place. I pay tribute to Sir Keith Pearson, who has been chair of the interim board for a number of months, for which he received no remuneration and travels at his own expense on a pro bono basis. He has offered much insight into how to turn the hospital around.

In response to the Deputy's question, the manpower would always be under review. The catchment issue is one that has come into the news recently. I assure the House that there is no legal basis for a catchment area per se. Patients who historically attended a hospital like to go back to that hospital because their notes are there and they do not need to go over their history again or remember all the tests they might have passed. That issue should not arise in the future. From the point of view of a hospital on a fixed budget, this is a major problem. However, as we move to a system based on the money following the patient, we should not hear complaints from hospitals about the patients who attend because they will be getting rewarded for each patient they see regardless of the part of the country from which they come.