Frank Fahey (Galway West, Fianna Fail)

I am delighted to have this opportunity, in the unavoidable absence on official business of my ministerial colleagues at the Department of Health and Children, to respond to the Senator on this important issue. Neither the Department of Health and Children nor the Eastern Regional Health Authority, which has responsibility for the provision of services at Peamount Hospital, is aware of any proposal to close the hospital.

The background to the future organisation and delivery of respiratory and TB services can be found in a report of a review on respiratory medicine carried out by Comhairle na nOspidéal, published in July 2000. This report found that, in line with major advances in medical treatment, the optimal in-patient care of patients with respiratory diseases, including tuberculosis, is more appropriate to local acute general hospitals, staffed by consultant respiratory physicians and other consultants and supported by an array of investigative facilities.

While recognising the valuable role Peamount Hospital had played for many years in the delivery of respiratory services, Comhairle did not regard it as an appropriate location for the future treatment of TB patients, especially those requiring ventilation and specialised treatment for other symptoms, including heart disease and HIV, who may present with tuberculosis.

Comhairle subsequently appointed a committee to advise on the implementation of the 2000 report. The report of this committee endorsed the recommendations in the 2000 report and was adopted by Comhairle in April 2003. Specifically, the committee recommended that Peamount Hospital should play an active role in the provision of a range of non-acute support services, including pulmonary rehabilitation, within the South Western Area Health Board. For example, it recommends that patients who have been treated in the nearby St. James's Hospital and other major acute hospitals, and who require ongoing rehabilitative care, could be transferred to Peamount Hospital for completion of their care.

In addition to the Comhairle advice on this issue, the board of Peamount Hospital has developed a strategic plan for the development of services at the hospital. The hospital employed external support to assist it in this process and to advise on developments in the wider health care environment. The strategy adopted by the board proposes considerable enhancement of existing services and development of new services in the areas of rehabilitation and continuing care of older people, persons with intellectual disabilities and adults with neurological or pulmonary illness.

On 22 March 2004, two of the senior medical personnel at Peamount Hospital secured interim High Court orders restraining their removal from their positions. The interim injunctions were granted to the medical director and senior medical officer. The matter arose by virtue of the termination by the hospital board of the medical director's post and revised arrangements for the senior medical officer's post arising from the new arrangements for the delivery of services at the hospital.

The hospital's policy on admissions to its TB and non-TB respiratory units has been clarified following the granting of a further interim injunction by the High Court on 31 March 2004 which stated that admissions to Peamount Hospital require hospital management approval. I understand a full hearing in the High Court was scheduled for today, 27 April 2004, but the outcome of this hearing is not yet known.

The admissions policy provides as follows. All new referrals to the hospital must first have been assessed in an acute general hospital — the recent transfer of a patient with multi-drug resistant tuberculosis to Peamount from the Mater Hospital, where he had been stabilised, is consistent with this approach; the transfer of patients from other hospitals to Peamount must be considered in the context of such patients being non-acute and on the basis of the transferring consultant being aware of the facilities and staff available at Peamount — this is in line with the recommendations of the Comhairle report regarding the future organisation and delivery of respiratory and tuberculosis services — Peamount does not have a Comhairle-approved consultant respiratory physician on its medical staff; elective scheduled admissions will be postponed until after the date set for the full High Court hearing, 27 April 2004, and rescheduled after that date — current patients with a diagnosis of malignancy will be admitted at the discretion of medical staff; and the out-patients department will continue to be maintained.

In light of this clarification of the hospital's admissions policy, a consultative process has now been initiated by the ERHA with all referring hospitals and health boards to ensure there is full awareness of Peamount Hospital's admissions policy. Within the functional area of the authority, hospitals are being asked to liaise with public health personnel regarding support requirements for patients with tuberculosis. The authority will also put in place contingency plans to manage patients locally.

Services in the Peamount Hospital, such as phlebotomy and X-ray, will continue to be available to the local community and much of the discussion to date has related to how the hospital can more effectively meet the primary care needs of the local population. After discussion with local general practitioners, it is clear that key concerns have arisen over the management of older people with chest infections and respiratory difficulties. The authority is in continuing discussion with the hospital on how these services will be maintained. This approach will be supported by the appointment of a consultant geriatrician to Tallaght and Peamount hospitals, approved by Comhairle, with two sessions per week specifically committed to Peamount. A joint consultant post in rehabilitation medicine is also being established between the National Rehabilitation Hospital and Peamount Hospital. Existing day and residential services for older people and people with intellectual and physical disabilities continue to be provided.

In conclusion, I am advised that the direction which Peamount is now taking will see it developing its overall role and its support for acute hospitals, general practitioners and the community of the surrounding area and is in line with its duty of care to patients and its commitment to the provision of the highest quality of care to existing and future patients.