Seanad debates

Tuesday, 27 January 2009

8:00 pm

Photo of Nicky McFaddenNicky McFadden (Fine Gael)
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I wish to share time with Senator Glynn. I thank the Minister of State for coming to the House to discuss the important matter. While I am concerned about general downgrading of services in the Midland Regional Hospital Mullingar, I raise in particular the urgent and grave matter of the downgrading of colposcopy services in the hospital. Women in the midlands deserve to have a colposcopy service. One of the most frightening moments any woman will experience is learning from her gynaecologist that a smear is abnormal. While an abnormal smear could mean a woman has cancer, the majority of such smears are caused by vaginal infection.

A pilot scheme headed by Dr. O'Reilly from Limerick was established in the Midland Regional Hospital Mullingar. As part of a plan, 19 centres around the country were in a position to participate in the screening programme. The programme was introduced in hospitals with full gynaecological services, namely, obstetrician, gynaecologist and inpatient services. The Midland Regional Hospital Mullingar, which has a full service, was assessed and deemed a suitable location for the screening programme and funding of €100,000 was provided. This money was spent on upgrading facilities at the hospital to provide a colposcopy suite and the programme was to link in with the national programme.

In October 2008, Dr. Flannery, who headed up the pilot scheme in place in the various centres, indicated that the Midland Regional Hospital Mullingar was not a suitable location for the service. However, she invited management at the hospital to submit a bid for the colposcopy service. Following submission of a bid, a reply issued by the quality officer at the beginning of this month stated that the hospital was not a suitable location for the service. The hospital was informed it did not have a sufficient number of potential patients as each centre should expect to treat 500 patients per annum. It is estimated, however, that between them, Mullingar and Portlaoise hospitals would have 850 patients per annum.

While the regional plan envisages the provision of a service in the midlands, I fear that, as in the case of the sexual assault unit, the service will be provided in Tullamore General Hospital. Any such decision would stink of politics because Tullamore General Hospital does not provide gynaecological services, employ an obstetrician or have a maternity unit. The Midland Regional Hospital Mullingar, on the other hand, provides all these inpatient facilities and has spent €100,000 on the colposcopy unit.

The Midland Regional Hospital Mullingar has lost its breast cancer service. Although I accept the necessity for centres of excellence to undertake the screening and treatment of breast cancer, I resent the gradual but consistent erosion of services in the wonderful facility of the Midland Regional Hospital Mullingar. This trend will cause instability and dysfunction in the hospital and is demoralising staff. The average turnaround for patients in the Midland Regional Hospital Mullingar is 3.5 days and, as Senator Glynn will agree, it is probably the most efficient hospital in the country.

I ask that the colposcopy service be retained for women in the midlands. It is already difficult for people in counties Longford, Westmeath and Laois to travel to Tullamore. Let us retain the central service in the Midland Regional Hospital Mullingar.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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I welcome the Minister of State to the House. Women are very important people in society. They are mothers who bear and rear our children and play a pivotal role in society. I hope my remarks are not interpreted as patronising.

The provision of the colposcopy service in Mullingar and the midlands region is important. The Midland Regional Hospital Mullingar is among the best performing hospitals in the country. I was pleased to note it received one of the highest ratings in the country recently.

Without ploughing old ground, I ask the Minister of State to ensure women living in the midlands region are able to avail of a colposcopy service. Too many young women die for want of appropriate services. Cancer is a word which strikes fear into everyone's heart. Its icy fingers clutch the individual's persona the moment the name is uttered. When people ask if one has heard whether so and so has "you know what" one does not need to second guess what the questioner means. Without labouring the point, I ask the Minister of State to convey to the Minister for Health and Children our concern that this service be available in the midlands region.

It is true that the Midland Regional Hospital Tullamore does not provide maternity services. I ask that a colposcopy service be brought on stream as expeditiously as possible, if possible in the Midland Regional Hospital Mullingar. I am surprised the hospital is not considered a suitable location for the service. While the experts are not always right, they are not always wrong either. I support what has been said and ask that the service be provided in the midlands region as a matter of urgency.

Photo of Seán HaugheySeán Haughey (Minister of State, Department of Education and Science; Minister of State, Department of Enterprise, Trade and Employment; Dublin North Central, Fianna Fail)
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I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

The national cancer screening service is responsible for implementation of CervicalCheck, the national cervical screening programme, which commenced last September. Colposcopy services are an integral part of a cervical screening programme. Women who have pre-cancerous cell changes detected by a smear test are referred for colposcopy. Prior to the commencement of CervicalCheck, much screening was carried out on an ad hoc basis and women were offered varying structures and processes of care, in addition to sometimes lengthy waiting times for colposcopy, where necessary. The roll-out of CervicalCheck has provided an opportunity to focus on the development and organisation of colposcopy services in Ireland.

The NCSS is responsible for the monitoring and audit of colposcopy services provided under the programme to ensure quality assured standards, based on those defined by the Royal College of Obstetricians and Gynaecologists, are adhered to. It is important to ensure that, as part of CervicalCheck, women can access colposcopy services within international best practice timeframes, based on adherence to quality assured clinical practice and the achievement of best clinical outcomes.

In preparation for the launch of the screening programme the NCSS, in co-operation with the Health Service Executive, completed an analysis of existing colposcopy services. This examined facilities, staffing, systems management, information management, information technology and governance. Based on this analysis, the NCSS initially identified 11 colposcopy services as being most prepared to receive referrals from CervicalCheck. A further four colposcopy services have since been identified to support the CervicalCheck programme, following a wide range of service enhancements. The NCSS is making a significant investment to enhance these services to ensure best outcomes for all women, regardless of location.

The colposcopy service at the Midland Regional Hospital Mullingar is not among the services identified as suitable to receive referrals from CervicalCheck. Historically, there has been a multiplicity of small-scale services in the midlands which do not meet quality assurance requirements. For clinics to become part of the programme, there is a requirement to demonstrate capacity for a minimum of 500 new referrals. For the midlands region as a whole, the projected total number of new colposcopy referrals is 868, based on Central Statistics Office figures and an 80% uptake rate of screening. The NCSS recognises the need for a colposcopy service in the midlands that can meet the quality assurance demands of the programme. The local hospital network manager is working actively with clinicians on the ground to ensure colposcopy services are delivered in the midlands. If a service in the midlands is identified in terms of scalable capacity, sustainable quality assurance and geographical location, the NCSS will assess its ability to provide support to enhance the resources, information technology facilities and equipment of such a service. In the meantime, women from the midlands region who require a colposcopy following screening through the CervicalCheck programme will be referred to one of the 15 quality assured services supported by the programme. The aim is to ensure best outcomes for all women, including those living in the midlands area.

Photo of Nicky McFaddenNicky McFadden (Fine Gael)
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I have a number of questions. Who made the decision to move colposcopy services from the midlands region? What is the evidence for using 500 new patients as a threshold? I have contrary evidence that the requirement for each practising colposcopist is to see at least 50 new patients, according to information from the United Kingdom. I do not know where the new figure of 500 has come from and would like the matter to be clarified.

Why have the four units in the midlands not been found to be suitable? Every other unit in the country has been found to be suitable. It seems crazy. Where are the results of the assessments comparing different units? Why have we not seen them? Terms such as "scalable capacity" and "sustainable quality assurance" are gobbledygook. Does the phrase "geographical location" mean that consultants are expected to travel from one area of the midlands to another? The service is being eroded from the Midland Regional Hospital Mullingar in front of our eyes. This is not acceptable.

Photo of Seán HaugheySeán Haughey (Minister of State, Department of Education and Science; Minister of State, Department of Enterprise, Trade and Employment; Dublin North Central, Fianna Fail)
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I am Minister of State at the Department of Education and Science and the Department of Enterprise, Trade and Employment.

Photo of Nicky McFaddenNicky McFadden (Fine Gael)
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I am disappointed the Minister is not here.

Photo of Seán HaugheySeán Haughey (Minister of State, Department of Education and Science; Minister of State, Department of Enterprise, Trade and Employment; Dublin North Central, Fianna Fail)
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The Senator has asked very technical questions and I have no doubt they are very important. I will bring them to the attention of the Minister for Health and Children and the HSE.