Tuesday, 11 May 2010
Accident and Emergency Services
I thank the Minister for Tourism, Culture and Sport for coming into the House to take this matter.
It has been reported that the HSE has made a decision to close accident and emergency departments in hospitals throughout the country. I specifically refer to the services provided at Wexford General Hospital in this regard.
A transformation programme has been discussed with public representatives and stakeholders throughout County Wexford during the past six months. The purpose of such discussions is to debate the transformation of all health services in the county. However, when one hears that accident and emergency services at Wexford General Hospital are under threat of closure, one gets a sense that people are being misled and treated in an underhand way by the HSE.
There is a lack of confidence not only in the HSE but also in the Government in respect of how health services in County Wexford are being operated. A number of acute beds at Wexford General Hospital were closed during the past 12 months and there are now plans to close St. Senan's Psychiatric Hospital, Enniscorthy, from next February. In addition, one hears talk of reduced services in the accident and emergency department in County Wexford. The excuse being given is that this pertains to the European working time directive. However, the directive has been in place for the past 15 years and clearly very little has been done on how it affects the delivery of services in acute hospitals.
The next excuse is that there is a lack of junior doctors. For years Ireland's health services have been run by exporting its own doctors and importing doctors from Third World countries. If there is such a lack of junior doctors, clearly there is a problem with the quality of some junior doctors. This issue has been highlighted previously but, again, nothing has been done about it. There also appears to be a problem with securing immigration visas for Third World doctors to work in the health service which contributes to the problem in providing hospital services. I do not know whether this constitutes a deliberate plan on the part of the HSE to somehow hinder the provision of doctors for accident and emergency departments, thereby enabling it to use this as an excuse to reduce services both in accident and emergency departments and other acute hospital provided services such as surgical services, both nationwide and in the south east, in particular.
If this measure is allowed to go ahead, it will put patients' lives at risk and certainly cause significant morbidity among patients because the ambulance service is not ready to take up the slack in transferring patients between Wexford and Waterford. Similarly, in Wexford there is a very good GP out-of-hours service which patients find highly satisfactory. However, it is not geared to taking over the role of dealing with accident and emergency cases. No discussions have taken place with Caredoc, the out-of-hours GP service, to even consider providing some of the out-of-hours accident and emergency services. Moreover, the GP service is under pressure. There is no confidence that the Minister for Health and Children will do her job for the people of County Wexford, if she intends to continue reducing services at Wexford General Hospital and in County Wexford while giving the impression that the Government has no plan or strategy. The Minister should indicate to Members what is Government policy in this regard. How will it affect accident and emergency services at Wexford General Hospital? What is the status of the transformation programme? I do not believe Members are getting the full truth from either the HSE or the Minister and that this is contributing to people's fears with regard to the provision of health services in County Wexford.
A number of protests have been organised in County Wexford, just like elsewhere in the country. There is a genuine role for an accident and emergency department at Wexford General Hospital, as Wexford is situated too far away from Waterford. Were the accident and emergency department at Wexford General Hospital to go, too many patients would be more than an hour's journey from either Waterford Regional Hospital or any of the accident and emergency departments located in Dublin. Some people in the north of the county would be obliged to travel to Dublin rather than trying to find their way to Waterford. However, a significant portion of the population of the county simply would be unable to access the accident and emergency department at Waterford Regional Hospital in a timely manner, with or without the assistance of either the ambulance service or the out-of-hours Caredoc service.
The Government is putting patients' lives at risk as County Wexford lacks both the requisite paramedics and trained personnel. Many of the county's general practitioners have received no accident and emergency service training. Moreover, very few of them have any experience of working in accident and emergency departments or acute trauma and life support services, in other words, of dealing with people involved in serious accidents either at work or by the side of the road. From this perspective, there is a need to keep the accident and emergency department open in order that patients can be seen quickly both to save lives and reduce the incidence of morbidity for patients if delays occur in securing the appropriate services at the appropriate time.
I have tabled this Adjournment Matter to receive an indication from the Government on where it stands on the issue. The perception of people in County Wexford is that they are being treated in an underhand fashion by the Government and that they are almost being deliberately misled by it as to its plans for the future of the county's health services. There has been no response from the Government to HIQA's recommendation that St. Senan's hospital be closed. Clearly, it intends to try to let the issue to fester until a last minute decision is made. This is also happening with regard to the accident and emergency department at Wexford General Hospital, that is, the Government is allowing the issue to fester before making a decision at the last minute. This is no way to treat the patients or people of County Wexford. The Minister should respond in a manner that will alleviate their concerns.
I thank Senator Twomey for sharing time with me. I support a great deal of the comments he made.
There is something underhand happening. Oireachtas Members have been brought to meetings by the HSE for nearly a year and have been drip-fed information. It is almost as though they have been brought down a particular road in an attempt to have them agree the accident and emergency services in Wexford should be reduced substantially. This is fundamentally and morally wrong.
In common with my parents and grandparents, I was born and bred in County Wexford. My family comes from south of Wexford town and the Wexford town area. Like Senator Twomey, we are from the larger hub of the county, in which the population is predominantly located. While some areas are closer to Waterford, I spoke to a lady on Friday who has a sick little boy who needs immediate care when he becomes ill. Although she lives in the bottom part of the county, at times it has taken her two and a half hours to get to Waterford Regional Hospital because one must cross the bridge at Ross, the bridge at Waterford and then get through Waterford city.
It is morally hazardous and wrong to expect a county as large as Wexford which has a population of 130,000 people to be without an accident and emergency service. If it is policy to prevent Members, as politicians, to intervene when something as fundamental as an accident and emergency department is under threat in a county the size of Wexford, they must question their position as politicians. I also will put this question to the Minister for Health and Children, Deputy Harney, because to leave this decision to clinicians negates Members' role as politicians. Matters such as the provision of accident and emergency departments or maternity services in a county as large as Wexford are the subject of political decisions. I support Senator Twomey in this Adjournment Matter.
I thank Senators Twomey and McDonald for raising what obviously is an important issue for them and County Wexford. On behalf of my colleague, the Minister for Health and Children, Deputy Harney, I will ensure the issues raised will revert directly to her. I reiterate that the Government is committed to ensuring the delivery of the best quality health service as possible and providing the highest possible standard of patient care in an effective and efficient manner within the resources available.
Wexford General Hospital plays an important part in the HSE south-east hospital network and there are no plans to lessen its importance in the provision of services. It provides acute services for a local population of 130,000 people. It benefits from a committed workforce who in 2010, in line with the hospital service plan, will provide services for approximately 13,000 inpatients, 6,700 day patients, 36,000 emergency department attendees and 2,300 mothers who will give birth in the maternity unit. In addition, it deals with more than 56,000 outpatient attendees each year. It has strong partnerships with colleagues working in the primary, community and continuing care sectors and aims to provide patients with fully integrated services.
In accordance with its transformation programme, the HSE is reviewing the current configuration of acute hospital services in the south east. A steering group is developing a plan for hospital reconfiguration that will deliver optimal and cost-effective services that are easily and readily accessible. The group comprises four clinical directors, one from each hospital, as well as the hospital network manager, and is supported by specialist advisory groups. All hospitals in the south eastern hospital group, namely, Wexford General Hospital, Waterford Regional Hospital, South Tipperary General Hospital and St. Luke's Hospital, Kilkenny, will be included in the plan for the revised model of care. No decisions on the roles of or services provided in any hospital will be taken until the plan is completed, following broad consultation within the services and with stakeholders generally. The review is expected to be completed and proposals brought forward later in the year.
The Government has shown its commitment to Wexford General Hospital in recent years with capital developments such as a new day oncology unit, an education centre and on-call accommodation. The hospital will continue to play a key role in the provision of hospital services in the south east.
I have been made aware from my contacts that there is a crisis in terms of the budget and the lack of availability of junior doctors, but that was not addressed in the Minister's reply. She should have been informed of that before she delivered her reply. Clearly, that crisis has been covered up in that it has not been admitted nor addressed. It was not dealt with in the Minister's reply. Most of her reply covered information contained in the HSE south-east report. The oncology unit, to which she referred, was paid for by the people of Wexford — they raised funds for it. I am disappointed that someone did not give the Minister an adequate answer to address what I know the HSE is talking about behind closed doors right now.