Dáil debates

Thursday, 16 May 2013

4:10 pm

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

While nobody can object to hospitals working together in groups and sharing services, a number of issues arise from the Higgins report on the establishment of hospital groups as a transition to independent hospital trusts, which was published this week by the Minister for Health. The absence of any specific commitments in the report for a number of hospitals nationwide raises questions about their future role in the health system. The report states, for example, that Letterkenny, Wexford and Kerry hospitals should continue to provide services currently available at those hospitals, which raises questions about the retention of services at other hospitals that have not been mentioned.

While it is recommended, for example, that in the Dublin east group, Wexford General Hospital should retain its full range of emergency, medical, surgical, maternity and pediatric services because of its geographical location, no such recommendation is made for St. Luke's in Kilkenny or the Midlands Regional Hospital in Mullingar. The likely fate of these hospitals is a cause for concern. Will they continue to provide the current level of services? St. Luke's in Kilkenny has an exemplary reputation for quality and efficient patient care. It is often seen as a role model for accident and emergency services. We are merely seeking clarity and we accept the need for reform of the delivery and configuration of health services. The same questions arise in respect of the south and south west group. It is recommended that Kerry hospital should keep what it has but no such recommendation is made for Clonmel. What is the position in this regard and can we be given an assurance that no change will be made to the services provided to south Tipperary?

The report goes to great lengths to reassure the people of Waterford, on foot of a vocal local campaign launched last year to retain services in the city's hospital, that it will continue to provide renal and cardiology services for the south east area. I presume Wexford and Kilkenny hospitals, which are in the Dublin east group, will continue to refer patients to Waterford.

In light of the decision to place Waterford Regional Hospital in a different hospital group, will a guarantee be given that hospitals in Wexford and Kilkenny will continue to make referrals to Waterford? I am concerned that this decision will result in a change of referral pattern, with referrals of cardiac and renal cases gradually shifting from Waterford Regional Hospital to Dublin hospitals that are in the same group as Wexford General Hospital and St. Luke's Hospital. I ask the Minister of State to clarify the matter.

The broader issue relates to the proposed hospital reconfiguration and transition to hospital trusts. The report on hospital groups states a board will be appointed and a chief executive officer will be recruited who must report back to the board with a plan for the new hospital group within one year of taking up the his or her position. The difficulty is that we do not know how hospital budgets will be reconfigured. How will the CEO, who will be the accounting officer, guarantee the services currently provided by the hospitals in each of the hospital groups? How will the Minister be able to guarantee services without a commitment to provide the capital and current funding required to provide the services outlined in the reconfiguration?

4:20 pm

Photo of Ciarán CannonCiarán Cannon (Galway East, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I am taking this debate on behalf of my colleague, the Minister for Health, Deputy James Reilly. I thank Deputy Kelleher for raising this matter and allowing me the opportunity to discuss with him the report the Minister for Health launched on Tuesday, which signals a fundamental modernisation of our health system organisation in line with best practice internationally. The traditional practice of providing as many services as possible in every hospital is neither sustainable nor safe. The formation of acute hospitals into groups, each with its own governance and management, will provide an optimum configuration for hospital services to deliver high quality, safe patient care in a cost-effective manner.

The current organisational structures have restricted the development of the management systems and leadership we require to run a world class national hospital network. In reforming these structures, the Minister wants to take the best elements of governance and autonomy found in our system to create a new governance framework that can yield the benefits of increased independence and greater control of local clinical and managerial leaders to every hospital. The introduction of groups will provide for organisational change in the first instance, giving more autonomy and better enabling the reorganisation of services in a well planned manner.

The hospital groups report is based on a comprehensive consultation process and contains almost 60 recommendations on the formation, management and governance of hospital groups. The objectives of the groups are to achieve the highest standard of quality and uniformity in hospital care across the group, deliver cost effective hospital care in a timely and sustainable manner, encourage and support clinical and managerial leaders, ensure high standards of governance both clinical and corporate and recruit and retain high quality nurses, non-consultant hospital doctors, consultants, allied health professionals and administrators in all our hospitals. The establishment of hospital groups will result in small and larger hospitals working together as teams.

Implementation of the hospital groups report will begin immediately. The Minister intends to seek and appoint chairs of each group within the next two months. Advertisements to seek other board members will be placed in parallel with the process of appointing the group chairs and the subsequent appointment of group CEOs and management teams. All appointments will be made based on the competences the individual brings to the board in line with the HIQA report on Tallaght. This will not prevent appropriate representation of the geographical areas in the group. The need to ensure primary and community care is also covered by the board membership.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Although I accept the difficulty involved in providing assurances, clear commitments were made previously to protect services in smaller hospitals. While the report refers specifically to some hospitals, it fails to mention others. For example, it does not specifically state that all services currently provided at St. Luke's Hospital, Kilkenny, and Clonmel General Hospital will be retained. On the other hand, it is at pains to point out that Wexford, Letterkenny and Tralee hospitals will retain their current services for reasons of geographical spread. This omission is causing concern.

To follow up on our discussion in the Chamber this morning, I am not condemning the hospital groups report. My party agrees that the proposed changes are necessary. However, it would give people confidence in the process if they were given an assurance that current services will be retained. This will be very difficult to do given that the chief executive officers of the various hospital boards will be given responsibility for drawing up a business plan that is to be submitted to the relevant boards and, subsequently, passed along the new chain of command, from the director of services to the HSE board to the Secretary General of the Department and, ultimately, to the Minister. This is a circuitous route. The CEOs will be required to live within the budget in delivering services and will, therefore, dictate which services will continue to be provided in which hospitals.

Photo of Ciarán CannonCiarán Cannon (Galway East, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Early on in the lifetime of this Government, our colleagues in opposition made a commitment to engage in constructive and positive opposition, which would be welcomed. I cannot understand the reason Deputy Kelleher is seeking to construct conspiracy theories about what is not in the report. Usually, one is criticised on the basis of the contents of a report. The Deputy appears to be drawing conclusions that no one else is drawing on the basis of what he describes as omissions or a lack of clarity in the report.

Each chief executive officer, in conjunction and collaboration with the chairman of the relevant hospital group, will decide how best to configure health services to serve the needs of each region. This is the autonomy about which I spoke. The needs of each region will be different, varied and unique. I am confident, however, that the new boards and their CEOs will be more than up to the challenge of deciding how best to allocate services in their respective regions. The purpose of this reform is to bring together all the expertise in the relevant region, across large and small hospitals, to provide the best possible care. Care should be provided, at least for more minor ailments and illnesses, as close to communities as possible and, where necessary, people should be transported to larger centres of excellence.

This is an excellent model, as the Deputy acknowledged, which has been broadly welcomed by everyone involved in the health service and many people in academia who recognise its value. I am sure the Deputy will agree that it deserves our support. While issues may arise during the roll-out of hospital groups, we have started on an interesting and exciting journey to provide the best possible health care for citizens.