Dáil debates
Tuesday, 12 December 2017
Topical Issue Debate
Hospital Services
6:15 pm
Peadar Tóibín (Meath West, Sinn Fein)
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I want to protest at the outset, and no harm to the Minister of State, Deputy Finian McGrath, about the fact that the Minister, Deputy Harris, has not come into the House to take this Topical Issue. Members do not get many opportunities to make a case on significant issues of health in their own counties and when they do, they like to ask questions and tease out issues. The Minister of State, Deputy McGrath, however, will only be able to read a script on this issue. That is not good enough.
Eighteen thousand patients visited the emergency department in Navan hospital in the past year, with 5,500 of those staying overnight in the medical unit in the hospital. Those figures are increasing. Our hospital is a great hospital and we have great staff in Meath. It has proven to be successful in reducing the length of time patients have to stay in the hospital and it has also been successful in reducing the level of readmissions to our hospital. It is one of the best hospitals in the country for dealing with people who have had heart attacks and strokes. It has also taken on a massive amount of new elective surgery from the Mater Hospital.
The hospital serves the whole of the county of Meath, which has a population that is growing radically. When I was a child, approximately 100,000 people lived in County Meath. There are now 200,000 of us and quarter of a million people will be living in the county within the next 20 years, making it one of the most populous counties in the country by far.
Not all the news is good, however. Last September, we saw the near collapse of the accident and emergency department in County Meath due to unofficial industrial action by agency doctors. Navan is more exposed than any other hospital to agency doctors and to this type of strike action because all of the doctors in the accident and emergency department are agency doctors. That means that the HSE does not want to give a full, decent contract to doctors working in the accident and emergency department in Navan because it does not expect there to be an accident and emergency department in Navan for long. Also, I have asked the Minister, Deputy Harris, a number of times by way of parliamentary questions the number of agency doctors and other agency staff working within the health service and I have been told by his Department that it does not know, which is a shocking indictment in terms of the way that service is being currently managed.
Navan used to have a great record with regard to trolley counts. It used to have one of the lowest trolley counts in the country. From January to the beginning of November this year, more than 2,200 people have been on trolleys in Navan. The numbers on trolleys have quadrupled in the space of one year. Why has that happened? Why is it the case that there are four times more people on trolleys so far this year than in the entirety of last year? What does the Minister of State intend to do about that? If a situation arises where there are delayed diagnoses there will be delayed treatment and if there is delayed treatment, there will be sub-optimum outcomes for patients, which is not good enough. I imagine one of the reasons for that is the fact that on a given day this year there were 20 people in Navan hospital who were clinically discharged, that is, 20 people for whom the doctors could do no more but who had nowhere else to go within the health service. Their pathway to further treatment was blocked. There are two State nursing homes in Meath and both of them have equally as many people waiting to get into them as are residents. It means that many people are in hospital beds in Navan because they have nowhere else to go. That is reducing the opportunity for people to access decent accident and emergency health services in County Meath.
Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I thank the Deputy for his co-operation.
Finian McGrath (Dublin Bay North, Independent)
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I first apologise for the Minister, Deputy Harris. I will deal with this issue.
I thank Deputy Tóibín for raising this important issue because for many years he has been a strong advocate for developing our health services and putting forward sensible suggestions. I strongly take his views on board. I am grateful to Deputy Tóibín for giving me the opportunity to update the House on accident and emergency services in County Meath. Tackling the challenges in emergency departments generally is a key commitment of the Government and I am delighted that €40 million in additional funding has been made available in 2017 as part of the 2018 budget to address winter pressures and waiting lists. That funding will be aimed at reducing overcrowding in our hospitals in this period through the provision of extra capacity and additional supports.
Our Lady’s Hospital, Navan provides a general acute hospital service to the catchment area of Meath and currently provides accident and emergency services in County Meath. Since 2013, the hospital has been part of the Ireland East Hospital Group. Every hospital in that group, large or small, has a vital role to play, with the smaller hospitals such as Navan managing routine, urgent or planned care locally, while more complex care is managed in the larger hospitals and with better linkages with primary, continuing and social care. As a smaller hospital, the challenge is to make sure that Navan provides more of the right type of services for the people of Meath, which can be safely be delivered in order that we maximise the benefit to all patients.
To ensure that the hospital continues to play a significant role in the Ireland East Hospital Group in providing sustainable, safe and effective care at the appropriate level of complexity, a number of developments already have been funded at Navan hospital in recent years. In addition to the refurbishment of the emergency department, there has been an upgrade of general theatres, an upgrade of the sterile services unit, the addition of new end-of-life care family rooms and a garden within the hospital, as well as an allocation of capital funding of €755,000 for the replacement of various equipment. There has also been an increase in day surgical activity, with surgeons from the Mater Hospital carrying out day surgery in Navan. Further developments regarding surgery and other clinical services at Navan are being considered by Ireland East Hospital Group.
The HSE has advised that there are no immediate plans to change the current emergency service configuration of services at Navan. The Ireland East Hospital Group is engaged in a programme of redesign work to further integrate and enhance the role of Navan hospital as a constituent hospital within the hospital group. The hospital group is continuing to engage closely with all interested parties to ensure that the needs of patients, staff and the local and wider community are addressed. Any changes to the emergency department services in Meath would only occur following consultation with key stakeholders, including health professionals at the hospital and other hospitals in the hospital groups, the National Ambulance Service, and community and public representatives.
Peadar Tóibín (Meath West, Sinn Fein)
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The Minister talks about creating extra resources within the health service but the small hospital framework document states that Our Lady's Hospital will lose accident and emergency, intensive care and coronary care services, as well as 24-hour anaesthesia. How is that increasing the resources within the hospital? I love this; this is rule by euphemism. We have a situation where redesign effectively means the downgrading of a level 3 hospital to a level 2 hospital. That is at a time when 94,764 people spent time on hospital trolleys last year in this State. Such is the pressure in Navan it is forced to open escalation wards that the Minister of State's Government will not even fund currently.
The Minister of State might be able to answer this question. I understand that the Minister, Deputy Harris, met the Ireland East Hospital Group very shortly after the budget. That group asked him if they could close the accident and emergency department in Navan. The Minister stated that it could close the accident and emergency department in Navan if it convinced the people of Meath that it was a good idea. I understand the Ireland East Hospital Group is working to try to convince local doctors that it is a good idea but how can it be a good idea? We only have to look at what happened in Cavan and Drogheda hospitals when Monaghan and Dundalk hospitals were closed.
Both of those hospitals were hammered with some of the highest waiting lists the country has ever seen. The contradiction in all of this is that, in 2015, the then Minister for Health visited Navan to open up the shiny new accident and emergency department. That Minster for Health was our current Taoiseach, Deputy Varadkar. There has been no change in the ability of Navan hospital to provide decent health care services. If it was good enough for Deputy Varadkar in 2015, should it not be good enough for the Minister of State at the Department of Health, Deputy Finian McGrath, and the current Minister of Health, Deputy Harris, that this service remains open and safe into the future?
6:25 pm
Finian McGrath (Dublin Bay North, Independent)
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I will bring the issues raised back to the Minister and will raise the Deputy's points very effectively. The Government has put additional funding into the emergency services this year. The emergency department at Navan hospital has been refurbished and €750,000 was provided for the replacement of various equipment. There has been an increase in day surgical activity. I am informed that, "The HSE has advised that there are no immediate plans to change the current emergency service configuration of services at Navan". That is what I have been told, but I will bring Deputy Tóibín's concerns back to the Minister and also the specific questions he asked about meetings. I am not aware of the meetings he mentioned.