Seán Fleming (Laois-Offaly, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I want to raise the issue of the cutbacks to accident and emergency services at Portlaoise which were announced recently, although some might say that no final decisions have been made.

There was a report in The Irish Timeslast September which stated that Department of Health submissions to the Government's comprehensive spending review suggested closing 24-hour services at five hospital accident and emergency departments, including Portlaoise hospital. For several months, the HSE, the Department of Health and the Department of Public Expenditure and Reform have planned for what was announced last week. It has now been said that no final decision has been made and that charade will continue for some time to come.

Since that announcement was made there have been further difficulties in Portlaoise hospital as a result of a lack of funding and resources provided by the Minister and the HSE. This time last year there were 41 people waiting over one year for an outpatient appointment. Today, the number has increased by 427 to 468 people, a tenfold increase, or a 1,000%, increase in the number of people.

We know there have been problems in the maternity unit. I will give the Minister credit for addressing them properly. The changes have resulted in an additional 15 or 16 staff being employed and the memorandum of understanding with the Coombe hospital, which is now managing the facility. We are happy to have national management and standards in the maternity unit in Portlaoise hospital. What is now needed is the same dedicated approach to the accident and emergency unit to ensure that additional staff can do their work.

I would be happy for St. James's Hospital, which is in the group, to take over the management and control of the accident and emergency department in Portlaoise hospital to ensure national standards apply and services are delivered there.

Brian Stanley (Laois-Offaly, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I welcome the opportunity to address this important issue and the fact three relevant Ministers are present. The HSE statement to local media on 3 June set the issue off, but there was some information about it beforehand. The relevant part of the statement referred to a complex planning process that, in the medium to longer term, will result in a reduction in emergency department opening hours overnight.

I do not need to make the case for the hospital in terms of the number of patients, motorways, the two large prisons in the area and that we need to have accident and emergency services available so that people can be brought in within the golden hour. It is not a case of parochialism and the Minister, Deputy Flanagan, knows that. This is a case of cold logic in terms of life and death.

The HIQA report highlighted shortcomings in the hospital in regard to a number of services, in particular maternity services. I compliment the Minister for the work that has been done regarding maternity services. It was long overdue. The Minister took the bull by the horns, did what needed to be done and recruited 16 extra front-line staff, which I welcome.

Dr. Susan O'Reilly, CEO of the Dublin Midlands Hospital Group, said on 26 February, "I intend to have 24 hours ED services continue in Portlaoise. You have surgical services that can provide general surgery. They need to be strengthened. I am confident we can continue to provide safe services." That is very clear. On 14 May the Minister said that the risk to patients in Portlaoise emergency department is very low as there are consultant staff and everyone is under the governance of a named consultant.

I want the Minister to address Government policy regarding regional hospitals like Portlaoise hospital where there is a long distance between accident and emergency units and they are strategically located on a road network, as well as taking the prison situation into account.

Martin Heydon (Kildare South, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Minister, Deputy Varadkar, for being present to take this very important issue. Recent media reports and commentary regarding Portlaoise hospital have been a cause of great concern for my constituents in Kildare South. Many have used the maternity services in Portlaoise hospital and many residents in Athy, Monasterevin and Newbridge have used the hospital as much as Naas. Portlaoise hospital also has a paediatric emergency department which Naas does not, as the Minister will be aware, and the next nearest paediatric emergency department is Tallaght hospital, which is a long way to drive from south Kildare if one has a sick child.

I am mindful of the HIQA report and the absolute necessity to ensure the safe delivery of services. I acknowledge the moves already made in Portlaoise hospital, including the Coombe hospital's management of maternity services, which is to be welcomed. Recent commentary about examining future complex surgery and the emergency department has caused major concern. Since the media report and commentary, Naas Hospital has seen a significant increase in the pressure on its emergency department. That, coupled with the fact that there were very few people on trolleys in Portlaoise hospital in the past week, means one can see the inextricable links between the two hospitals, even when there was media commentary about the future of Portlaoise hospital.

I do not want to see the loss of the 24/7 emergency department in Portlaoise hospital in the future, but in any review that looks to maximise safety and the provision of services following the HIQA report, I want the safety of patients in Naas General Hospital and the residents of south Kildare's safety to be considered equally with that of Portlaoise hospital. There needs to be an acceptance that any decisions in Portlaoise hospital have a direct impact on the services in Naas General Hospital and Kildare.

I want a commitment from the Minister in the House that there will be no change to the services in Portlaoise hospital without due consideration of the impact on Naas General Hospital and south Kildare. We need to increase the capacity of Naas General Hospital as it is. The endoscopy unit and day ward plan for Naas General Hospital need to be constructed in 2015, not started in 2016 as originally planned. The building needs to commence, even if Portlaoise hospital maintains its currents services due to the size and scale of our county.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Deputies for giving me the opportunity to again update the House or plans for Portlaoise hospital. The Government is committed to securing and further developing the role of Portlaoise hospital as a constituent hospital within the Dublin Midlands Hospital Group, which also includes St James's, Tallaght, Tullamore, Naas and the Coombe hospitals.

Any change to services at Portlaoise hospital will be undertaken in a planned and orderly manner and will take account of existing patient flows, demands in other hospitals and the need to develop particular services at Portlaoise hospital in the context of overall service reorganisation in the Dublin Midlands Hospital Group. Decisions will be made on the basis of maximising patient safety and patient outcomes, not financial considerations, and that is the only guarantee I can give.

In recent months, substantial investment and enhancement measures have been put in place to ensure a safer level of service at the hospital. Maternity services will be upgraded following a memo of understanding between the HSE and the Coombe hospital to provide a managed clinical maternity network within the Dublin Midlands Hospital Group. Furthermore, improvements in Portlaoise hospital generally include a number of additional consultants posts in anaesthetics, surgery, emergency medicine, paediatrics, obstetrics and medicine, and an additional 16 midwifery posts. It is also intended to provide a new acute medical admissions unit and to expand day surgery, and a new paediatric emergency triage unit is being developed.

The group CEO has set out clearly what is being proposed for Portlaoise hospital and has made it clear that maternity, acute medical and paediatric services will continue, as will 24/7 anaesthetics, and that elective day surgery is likely to be expanded. Patient safety and best clinical outcomes for patients must come first and, as Deputies are aware, last week the HSE advised that complex surgery, such as bowel surgery, in Portlaoise hospital will be transferred to St. James's Hospital or Tullamore hospital as the volumes are too low to maintain the requisite expertise of clinical staff.

Indeed, the HIQA report specifically criticises the HSE for recruiting additional consultant surgeons at Portlaoise hospital when patient numbers were not sufficient to allow them to maintain their skills. Anyone who is perpetrating the nonsense that this is about resources needs to read and understand that report. The HSE was criticised for hiring more consultants and overstaffing a service, thereby making it unsafe because the patient load was not adequate.

Currently, all categories of surgical patients can arrive at the emergency department at Portlaoise hospital. The hospital group, in collaboration with Portlaoise hospital and other hospitals in the group, need to plan for how some of these patients can be transferred and cared for in the most appropriate high volume surgical services within the group.

Deputy Stanley referred to the golden hour. It is important to understand to what that applies and means. It is particularly relevant for something like an ST elevation MI, STEMI, where ideally one needs to be in a cath lab within 90 minutes of diagnosis. Going to Portlaoise hospital now is not a good idea if one has a STEMI because it does not have a 24/7 cath lab. People with STEMIs are not taken to Portlaoise hospital because they will not be treated within the golden hour. The same applies to major trauma orthopaedics. Such patients are not and should not be taken to Portlaoise hospital, because they need to be taken to a major trauma centre. That is why they are taken to Tullamore hospital.

The important point to understand here is that work is being done to strengthen services in Portlaoise hospital from a patient safety and quality perspective and to ensure that services currently provided by the hospital that are not viable are discontinued and those that are, are safety assured and adequately resourced.

This is also in keeping with the recommendations of the report by HIQA into services at the hospital and indeed other hospitals.

The emergency department at Portlaoise hospital has between 30,000 and 40,000 attendances per year. Its patient experience times are the best in the country. There is no question, therefore, of it being closed. The only question that has emerged, as raised by the chief executive officer, is whether 24-hour services are sustainable. No decision in this regard has been made or can yet be made. In the case of Navan, for example, surgical services are no longer provided but the hospital continues a 24-hour emergency department for medical patients and those with minor injuries.

I strongly agree that any proposal to end 24-hour services at Portlaoise could not be advanced without a clear and credible plan to provide additional capacity at Tullamore, Naas and Tallaght hospitals, which are already overstretched. At the same time, I hope Deputies understand that a hospital that does not and cannot do complex surgery is not the best place to take a patient who needs complex surgery in an emergency, for the obvious reason that it cannot be done there.

Seán Fleming (Laois-Offaly, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Minister for his reply. He has given a commitment to meet with public representatives from County Laois some day next week, along with his colleague the Minister for Foreign Affairs and Trade, Deputy Charles Flanagan.

He stated that changes would happen but that they would be done on a planned basis. He also stated that the CAT scan does not operate on a 24-hour basis.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

No. I said there was no cath lab in Portlaoise.

Seán Fleming (Laois-Offaly, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Okay. Will he clarify for how many hours the CT scanner is open in the hospital?

The real concern is about the downgrade. We already understand the ambulance protocols that are in place. If there is a serious accident on a motorway, even within a mile of Portlaoise hospital, those with broken limbs will be sent to Tullamore, as it deals with orthopaedic issues. If one has a stroke in County Laois, one goes to Naas. Those protocols are already in place and people are satisfied with them. To say that the facility will be for medical patients with minor injuries, as is happening at Navan, is essentially a downgrade.

If the service is scaled back from 24-hour to 12-hour, people will stop going to the hospital in the evening because they might not be seen by eight o’clock. The regional manager has suggested that people who are not in the immediate vicinity of Portlaoise should be going somewhere else to start with. There is a plan in place, whether it is on the Minister’s desk or not - and he should know about it - to reduce the numbers attending Portlaoise hospital so that the HSE can ultimately say the service is not sustainable in the interests of patient safety. Once one starts reducing the hours from 24, one is on the slippery slope.

Brian Stanley (Laois-Offaly, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I thank the Minister for his reply and welcome his acceptance that Naas, Tullamore and Tallaght are already overstretched. The concern is that the acute medical unit may be used as a replacement for the emergency department. Being a medical person, the Minister will understand that these are two very different facilities.

I accept his point about the golden hour and stabilised patients. However, it is necessary to have an accident and emergency unit in the hospital because of the case I outlined earlier. To have the accident and emergency unit staffed properly with proper consultancy cover is important.

I am concerned about the grouping of emergency services among some of the Dublin hospitals. It has been done already with maternity services in Portlaoise, which people accepted. This is not blind parochialism. The case was made for this and the results so far have been good. That, along with the extra staff recruited to the maternity service, is a positive step.

The hospital needs new accommodation for its maternity unit. I accept that no final decision has been made. However, I do not want the Government dragging this process beyond the general election. We want this sorted. The situation with Abbeyleix hospital has been allowed to drag on for three years since the public consultation process ended. This cannot be allowed to happen with this hospital, as it is an important issue. I hope it is resolved quickly.

Martin Heydon (Kildare South, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Minister for his detailed response. I welcome his statement on maximising resources and improving outcomes and the fact that it is not about financial considerations. We are all on the same page when it comes to patient safety and quality. It is about finding the best way to achieve that for the residents of Counties Laois and Kildare. I also welcome his acknowledgement of the pressure that management, staff and patients in Naas hospital are experiencing. In acknowledging that, we then have to figure out how best we can alleviate it both in the short and long term.

Kildare has a population of 210,000 people but it has a disproportionate number of nursing homes, particularly in the north of the county, because there are fewer of them in Dublin. That means some of the patients who present at Naas are older and sicker compared to those presenting at other hospitals, which brings its own pressures. The emergency department in Naas has eight cubicles and two resource rooms. This is not enough for the size of the population in Kildare. We are lucky to have an amazing staff in Naas hospital who work under intense pressure. We need to relieve the pressure and ensure it is not intensified by any future actions. Construction of the endoscopic unit needs to be commenced this year. As part of that build, there is the potential to build several extra wards. Will this be considered by the HSE and the Department as a means of addressing the pressure that Naas hospital is under? I also welcome the Minister's statement that no decision would be made without due consideration for Naas.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I very much agree that the maternity ward in Portlaoise hospital needs a capital investment. This will be discussed with the master of the Coombe and others in the next while. The unit in Portlaoise is probably about 30 to 50 years old. However, Deputies should bear in mind that there are other hospitals, both paediatric and maternity, that are 200 years to 300 years old. Unfortunately, we need to prioritise which need investment first.

The potential impact of any changes on Naas, Tullamore and Tallaght is fully understood. We have seen reconfiguration without adequate provision in other regions in the past. In the north east enormous pressure was put on Drogheda, while in the mid-west it was Limerick that bore the brunt. That was done by the last Government and I do not intend to repeat it. It was right to do the reconfiguring, but the central hospitals should have been properly resourced too.

What I cannot do is give absolute commitments. No honest politician can and nobody should trust a politician who goes around making absolute commitments about the future because we cannot predict it. What if it turns out that we cannot hire senior staff to work an emergency department at night? It will not be possible in ten or 15 years to be staffing emergency departments at night with locum doctors with poor English and no emergency training. That might have been fine ten years ago, and we might even get away with it now. However, that is not the kind of health service we want in ten years’ time. We have to know we can staff it with senior staff.

We also have to ensure we can indemnify it. What if the State Claims Agency were to remove indemnification? Will we then ask patients to sign a waiver before they go in at night to say they will not sue if anything goes wrong? Anyone making these kind of cast-iron promises for the future is just not an honest person. I was disappointed to hear Deputy Sean Fleming make those kind of undertakings. Will he tell the people of Laois if he has discussed this with his party leader, Deputy Martin, and whether Fianna Fáil will stand over that commitment as a party? It should be borne in mind that Deputy Martin, one of the most senior politicians in Cork and a Minister in the last Government, was in power when the number of 24-7 emergency departments in County Cork was reduced from five to two. That was done in his county and he stood over it. He was right to do so. Can Deputy Fleming be sincere about his commitments when his party leader did the exact opposite in his own county?