Dáil debates

Wednesday, 24 October 2012

Topical Issue Debate

Hospital Services

3:25 pm

Photo of Derek NolanDerek Nolan (Galway West, Labour)
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I welcome the opportunity to speak about this very important issue. Before I address it, I commend the Minister for Health for the work he has done with regard to the Galway-Roscommon hospital group which is making significant strides in tackling some long outstanding performance issues. The new management team is achieving great results in reducing inpatient waiting lists and times, the emergency department count and trolley figures. It is a tribute to the chief executive officer, Mr. Bill Maher, and the chief operations officer, Mr. Tony Canavan, but also to the co-operation of staff, nurses and doctors who are putting their shoulders to the wheel in delivering improvements, achieving efficiencies and finding new ways of working. They all deserve recognition and credit for their hard work and commitment.

However, while we have seen positive results in some areas of the health service in Galway, it is a harsh reality that waiting times in other areas remain unacceptable. I refer specifically to the urgent need to address the waiting times for the pain clinics in University Hospital Galway and Merlin Park University Hospital. The waiting times in both are totally unacceptable and are causing extreme distress and discomfort to many people who are in dire need of medical attention. I commend the staff who work in the pain clinics in the health service for the helpful and co-operative fashion in which they have dealt with queries from my office. According to statistics I received yesterday, there are now 583 people waiting for an appointment, with the longest wait time being since August 2010.

I have met with many people in Galway who have turned to me for help, completely exasperated with the delays in attending the pain clinics. One constituent who came to me for help and to highlight his plight was a gentleman who was diagnosed with fibromyalgia and who suffers pain in all 18 tender points in his body. His condition has deteriorated in recent years but this year has been his worst to date. Almost every week there are at least three nights where he literally does not sleep and cannot even face going to bed because the pain is so bad. He used to have a photographic memory and was a successful computer programmer. He now suffers from chronic muscle pain in his joints and nerves and regularly experiences memory loss. This man has been waiting since the start of the year to get an appointment at the pain clinic in University Hospital Galway. He was added to the waiting list on the 3 January 2012. Today is the 24 October, almost ten months down the line and he is still waiting. He is still suffering tremendous pain, and he is still fighting to maintain a decent quality of life. Since January he has had one pain free day - one day in ten months that he did not have chronic pain in his joints and nerves.

Other cases have been presented to me of patients with chronic back pain. Another constituent with severe multiple sclerosis was forced to wait months for an injection that would restore mobility, the ability to work from home and dignity to her life. She was once able to receive the injections she so badly needs every eight weeks but now the service has been scaled back. In the meantime she is confined to bed, dependent on her family and unable to function properly.

I am aware of the challenges that face the Department of Health and the Ministers in the Department. The HSE has always suffered administratively and I believe the promised reforms will tackle some of the problems. However, the waiting times for the pain clinic at Galway University Hospital had gone way beyond what is acceptable for a health service. People who are in chronic pain are waiting for an appointment to give them some slight relief from medical conditions which have dominated their lives. I ask the Minister of State to ask the Minister for Health to make a commitment to tackle the problem. It is extremely unfair to expect people who are living with debilitating pain to wait an intolerable length of time to get the treatment and relief they deserve.

3:35 pm

Photo of Jan O'SullivanJan O'Sullivan (Limerick City, Labour)
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I thank Deputy Nolan for raising the issue to which I will respond on behalf of my colleague, the Minister for Health, Deputy James Reilly.

University Hospital Galway has two consultants who provide a pain management clinic in the hospital. These are consultants who specialise in anaesthesia, 50% of whose time is allocated specifically to pain management. Two pain clinic sessions take place each week. In addition, the pain clinic has weekly theatre access for interventional and non-interventional procedures. To support this service, the hospital has provided a resource of three clinical nurse specialists whose time is divided between acute and chronic pain management for both inpatients and those attending the clinics on an outpatient basis. All pain clinic patients can contact the nurses by phone or bleep.

Escalation protocols are also in place to address changes in patient symptoms. If patients are on the outpatient waiting list and their symptoms worsen they can contact their GP who can liaise with the consultants directly. If patients with chronic pain have an acute exacerbation of their symptoms they can attend the emergency department. If existing patients are experiencing any difficulties or worsening symptoms they can contact directly the clinical nurse specialists for pain relief. Patients who have received interventional pain treatment and require a repeat procedure are returned to the waiting list and are prioritised if cancellations occur.

It is regrettable that a small number of patients have encountered delays in receiving appointments for the pain clinic. However, in line with the strict policies introduced by the Department of Health, patients are added to the pain clinic waiting list according to their referral date, and patients are taken off the list according to clinical priority and referral date. Since assuming office, the Minister, Deputy Reilly, has made it clear that priority must be given to taking care of those patients waiting the longest. Once the most urgent cases are treated, hospitals must devote their capacity to treating the longest waiters in a strict chronological order, which is the fairest approach. Progress on waiting lists shows that even with reduced budgets and staffing levels, clear, well informed targets assist hospitals to be effective.

Within the past week there has been a reduction in the overall waiting lists across the country of 16%; in University Hospital Galway itself, access for procedures has improved by 40% since 2011; most notably, considering the difficulties it was encountering in December last year, the hospital achieved the nine month primary targeting list for inpatient waiting lists on 30 September 2012. On behalf of the Minister I thank all the staff involved and acknowledge their dedication and commitment to those significant achievements.

Photo of Derek NolanDerek Nolan (Galway West, Labour)
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I reiterate my compliments to the staff working in the hospital on the dramatic improvement in many of its services. I regret that the Minister of State, Deputy Jan O'Sullivan, must respond to the issue and that the Minister for Health could not be present to respond because what I raise is extremely important. People to whom I have spoken have rung the pain clinic on a weekly basis. Their doctors have written to the pain clinic asking for speedier referrals and treatment to no avail. I contend that some of the information provided by the Department of Health in the response is slightly inaccurate. It is not something many of those I have met experience. While I appreciate the sentiment of the response, that alone will not solve the problem. The problem is clear. There are two consultants and we need more. There are three clinical nurses and we need more. The reality is that those on the waiting list for the pain clinic in Galway are in pain. They are not waiting for a diagnosis; they are in pain and are seeking treatment for the pain. Each additional week they wait is an extra week in pain. Each additional month they wait is another month in pain. In some circumstances those who are waiting are immobile while others are in agony.

I am not happy with the answer I received. I appreciate that the issue does not relate to the Minister of State's brief. I urge her to speak to the Minister for Health, Deputy Reilly, explain the details of the cases I have raised, in particular the case to which I referred in my initial statement, and ask him to put a specific plan in place, perhaps via a special delivery unit or by agreement with hospital management in the Galway University Hospitals, to deal with the severe delays and frustrations experienced by patients in pain while they wait for pain clinic appointments. In many cases they suffer so much that their lives are debilitated.

Photo of Jan O'SullivanJan O'Sullivan (Limerick City, Labour)
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Deputy Nolan clearly outlined the difficult position of such patients. I will convey his concerns directly to the Minister, Deputy Reilly. We all want the quickest possible responses to patients in pain or who need care in other ways. The Deputy acknowledged the progress that has been made in various areas. I will convey the issues raised to the Minister and the suggestions Deputy Nolan has made on how to address it, including the special delivery unit. I apologise for not being able to provide a more precise answer as I am not in the Department concerned.