Dáil debates

Thursday, 12 July 2012

Topical Issue Debate

Acute Hospital Services

3:00 pm

Photo of Michelle MulherinMichelle Mulherin (Mayo, Fine Gael)
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The acute services at Mayo General Hospital are under considerable pressure and that is why I am bringing the matter to the Minister's attention. I am asking him to intervene to change the situation. In the past year, there has been an increase of nearly 28% of people presenting to the accident and emergency department in that hospital. As a result, there has been an increase of almost 9% in admissions. The Minister might ask whether they are striving for efficiencies to do their business in the way he and the HSE have outlined for hospitals to conduct themselves. I fully support that but this hospital, its management and the HSE team in the area are very much tuned into the Minister's policy and philosophy. In fact, these statistics are no reflection on the hospital's management because last year it boasted health figures placing it as one of the best performing hospitals in the country. The performance included a 64% reduction in people waiting on trolleys, which compared to a national average of 20%. Therefore the hospital management has been listening and has been trying to implement the Minister's guidelines.

Mayo General Hospital has been assessed by the Minister's special delivery unit and was found to be running efficiently, which is a reflection on the sort of work being undertaken there. However, major pressure is being placed on the hospital as a result of the closure of the accident and emergency department at Roscommon Hospital. Following an examination of relevant data, it has been found that many people presenting to Mayo General Hospital have addresses in County Roscommon.

I have cited figures for presentations and admissions at the accident and emergency department in Mayo General Hospital, but figures for the same period in University College Hospital, Galway, showed a 10% reduction in presentations to the accident and emergency department and a reduction of 5% in admissions.

It is significant that another tranche of people presenting to the accident and emergency department in Mayo General Hospital have addresses in north Galway. Anecdotal evidence points to the fact that people from Roscommon are either going to Mayo General Hospital or Sligo Hospital, and are not going to UCHG. Having visited UCHG's accident and emergency department on a number of occasions, I understand there is a problem in accessing it and it is already under pressure. This situation concerns people in counties Galway, Roscommon and Mayo.

When the accident and emergency department was closed in Roscommon Hospital there was no transfer of resources to Mayo General Hospital, notwithstanding the fact that fewer people were presenting or being admitted in Roscommon. As far as I understand it, the same teams are still there, although dealing with fewer people. That matter needs to be addressed.

Funding from the Minister's special delivery unit should be given to two intermediate care teams, which would take people out of hospital. It would also provide nursing staff, physiotherapy, occupational therapy and health care assistants in order to provide emergency interventions in people's own homes so they would not occupy hospital beds. This in turn would avoid unnecessary admissions to Mayo General Hospital or long-stay residential care, as well as allowing for an earlier discharge of patients from the acute sector.

It would naturally be a better use of the hospital's resources in addition to providing 24-hour nursing care with therapy interventions in the home. Over a maximum 12-week rehabilitation period, that should see patients referring to normal community services afterwards. In the interim, it would keep them well away from Mayo General Hospital, which has an average length of stay of 6.2 days for patients. That compares favourably with other statistics.

The Minister has set aside €28 million to address this issue so that people will not be on trolleys and to target acute services where they are needed. It is an expensive process and costs approximately €1,000 per day to keep someone in Mayo General Hospital. The cost for a step-down facility comes to about €400 or €500 per week. It makes financial sense to keep people out of acute hospital services. Mayo General Hospital is carrying an extra burden and I hope the Minister recognises that. The facts and figures are there to back it up. I am asking the Minister to make an allocation from that fund to the acute services.

Photo of James ReillyJames Reilly (Minister, Department of Health; Dublin North, Fine Gael)
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I thank the Deputy for raising this issue.

The Government is committed to ensuring that patients receive the highest standard of care in the appropriate settings be they acute, community or residential. The traditional focus on the institution rather than the patient must be changed. To this end, we support older people to live at home and in their communities for as long as possible. This is realised through a range of community-based services, including mainstream home help, enhanced home care packages, meals-on-wheels and respite or day care. These services are designed to be as flexible as possible to best meet the needs of individual recipients and their families.

In tangible terms, the investment dedicated to services for older people is significant by any standard with, for example, just over €1.4 billion being provided this year for the health sector alone, of which approximately €350 million is for HSE home supports. These services are often delivered on a partnership basis with the not-for-profit and private sectors. We also provide a number of short term care beds nationally, including convalescence, respite, rehabilitation and palliative care beds. In total, there are just under 2,000 short term care beds currently available nationally. Intermediate care is a key component in delivering a continuum of services and particularly in delivering the appropriate care at the lowest level of complexity.

There are currently 160 short term or intermediate care beds available in Mayo General Hospital. I am aware that the hospital made a submission for inclusion in a pilot project on intermediate care being undertaken in my Department by the special delivery unit. The business case suggested the development of two intermediate care teams in Mayo, one in the south of the county and another in the north. The aim of these teams is to avoid unnecessary admissions to hospital or long stay care units, enable a more efficient hospital discharge, provide home care services for those who need help to recover from an illness or injury and to bridge the gap between primary and secondary care. The criteria for admission to this home based service is as follows: clients should be over 65 years of age, clients should have had a recent episode which resulted in a deterioration in their condition, clients have the potential for improvement-rehabilitation within a 12 month period and that the client reside in a catchment area. The cost associated with the development of the two teams is estimated to be €907,000.

The special delivery unit is still considering all of the submissions received regarding this initiative. No final decision has been made concerning the areas to be covered or the extent of these initiatives. However, the submission from HSE west in respect of Mayo General Hospital will be considered with all of the other submissions.

Photo of Michelle MulherinMichelle Mulherin (Mayo, Fine Gael)
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I thank the Minister for his response. I would welcome a comment from the Minister on the requirement on Mayo General Hospital to cope, without additional resources, with patients who previously would have gone to the accident and emergency department at Roscommon General Hospital.

I understand that €18 million of the €28 million has been allocated to the Dublin and mid-Leinster regions. Can I take it from the Minister's response that the provision of additional funding for Mayo General Hospital is still under consideration by the special delivery unit and that notwithstanding the recent announcement in regard to the €18 million there is more funding in the pipeline for worthy proposals such as this?

Photo of James ReillyJames Reilly (Minister, Department of Health; Dublin North, Fine Gael)
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There is no question or doubt but that patients from Roscommon have been for a long time opting to go to Mayo General Hospital, Sligo General Hospital, Portiuncula Hospital and Galway University Hospital. A survey taken a couple of years ago indicated that only 9% of people with an address in Roscommon were attending the hospital in Roscommon, with the remainder attending other hospitals. It is our intention to reverse this trend by ensuring the provision of more safe services at Roscommon General Hospital so that more people from Roscommon and beyond can be treated there.

On the matter of additional funding for Mayo General Hospital, I must advise the Deputy that Portiuncula Hospital, Galway University Hospital and Sligo General Hospital have not received additional funding. The reality is that we are on an extremely tight budget, with the troika in town every three months examining all budgets. We do not, therefore, have the latitude we had in previous years. As I stated, the provision of additional funding remains under consideration. No final decision has yet been made.