Thursday, 29 September 2011
I welcome the Minister of State to the House for this Adjournment matter. The Minister for Health recently confirmed that there will be a reduction in the opening hours of the minor injuries unit in Monaghan General Hospital to an eight hour, five day service to take effect from 1 November. Essentially, minor injuries will only be dealt with in Monaghan during business hours. Who knew that medical injuries had business hours and could be dealt with in that way? The reduction in hours for the minor injuries unit is a serious and life-threatening matter and it could be dealt with by the Fine Gael and Labour Party Government if there was a strong political will to do so.
The stripping of services from Monaghan General Hospital will have a massive knock-on effect on Cavan General Hospital and Our Lady of Lourdes Hospital in Drogheda. These hospitals are already unable to cope with the demands currently made on them. Every day we hear about hospital overcrowding with patients on trolleys, chairs and even on the floors of hospitals throughout the State. In addition to these service cuts and the centralisation of services at Cavan and Drogheda, there are ongoing cuts in health spending and the embargo on recruitment in the health services. Front-line staff in Cavan, like those in Monaghan, Drogheda and Dundalk, are doing their best in the face of insufficient resources and, indeed, poor planning by the HSE and the last Government. Does the Minister, Deputy James Reilly, support his party's local councillors and some of his party's Deputies in the north-east region of Cavan, Monaghan and Louth who have opposed the transformation agenda?
The decision to reduce this unit's hours is more about saving money for the Government than about patient care and safety. We are told the annual savings from the reduction will be approximately €400,000. What about the people who cannot travel to other hospitals outside these hours, the people who are living on the breadline and who are struggling to survive? What about those who have a minor injury but who cannot arrange a lift to a hospital further away in Cavan and Louth? The roads linking Cavan, Monaghan and Louth are not exactly the best. What about the overcrowded accident and emergency departments where seriously ill people are already waiting for hours to be seen? Is it prudent to reduce the hours of the minor injuries unit? It means that outside these hours other hospital services will be flooded with minor injuries that could have been dealt with in a more timely and efficient manner.
We should consider how the axe fell in this case. The current Minister for Health promised the people of Monaghan before the election that there would not be a reduction in hours. Post-election, however, the axe was sharpened and the services in Monaghan General Hospital have been hatcheted once more. In a reply to a parliamentary question from my colleague, Deputy Ó Caoláin, the Minister said: "Underlying the health service is the principle that the patient should be treated at the lowest level of complexity that is safe, timely, efficient and as near to home as possible." Now, however, the Minister is presiding over a reduction in hours for the most basic and closest services for the people of Monaghan.
Has any consideration been given to the knock-on effects and to the effects of reducing the hours of a service for the lowest level of complexity at Monaghan General Hospital? Finally, will the Minister make a commitment to revisit the failed hospital configuration in the north east, specifically as it affects Monaghan General Hospital, while recognising the knock-on effects on Cavan General Hospital and the impact of the loss of services at both Louth County Hospital and Our Lady's Hospital in Navan?
I am replying to this Adjournment matter on behalf of my colleague the Minister for Health, Deputy James Reilly, and I thank the Senator for raising it.
In view of the current budgetary and financial position the efficiency of services is being reviewed by the HSE. The Minister has emphasised to the HSE that budgetary compliance must be maintained alongside the delivery of service levels set out in the national service plan. In this regard the minor injury unit, MIU, in Monaghan General Hospital was analysed by the HSE in terms of risk assessment, patient activity levels, staff resources, service impact and service unit cost. The review was undertaken in the context of addressing levels of agency and overtime costs in the Cavan-Monaghan hospital group.
The minor injury unit in Monaghan opened in July 2009 and currently provides a service seven days a week from 9 a.m. to 9.30 p.m., with two nursing staff and a registrar in emergency medicine rostered on duty during these hours. Based on statistics for the first six months of the year, the unit sees, on average, 23 patients a day, six of whom are repeat patients. On average, seven patients a day attend the unit after 5 p.m. In the light of this analysis, the HSE has decided to change the opening times to 9 a.m. to 5 p.m., Monday to Friday, and expects the revised hours to take effect from 1 November. This change is the direct result of the current budgetary and financial position facing the health system. While the HSE has reviewed other possible options to save money or increase revenue, it has concluded that they would not generate sufficient savings in the short term. It has estimated that full year savings of almost €400,000 would be generated with the alteration of opening hours. The change to the unit in Monaghan is to be viewed as a temporary measure and will be reviewed in 2012 in the light of budgetary considerations and patient activity levels at the unit in the future.
The Minister for Health has emphasised to the HSE the need to ensure the impact of such changes on patients is minimised and that all changes are fully communicated. The HSE has advised the Minister that patients attending the unit after 5 p.m. are mostly review patients who are recalled to the service and can be easily accommodated with minimal inconvenience within the changed opening times. The Minister has also been informed that the internal communications to date in Monaghan hospital have included a series of meetings with key staff and their union representatives and that agreement has been reached on a number of staff redeployments to specific areas of choice.
An external communication plan for members of the public, local GPs, public representatives, media and key stakeholders is being finalised. Part of the plan will be a public awareness campaign to minimise the impact of the service change on patients. All decisions on the alteration of patient services are carried out by the HSE in the interests of patient safety and kept under regular review.
When in 2012 will the review of this temporary measure be carried out? There is a danger that the opening times will be further restricted. Will an analysis be conducted of the patients who had to attend hospitals in Cavan, Dundalk and Drogheda outside the unit's opening hours? If we are examining activity levels of patients who need minor injury care outside the unit's opening hours, it is important to determine how many had to travel elsewhere.
The HSE will keep the matter under review. The decision will be formally reviewed early next year once the new arrangements have been in place for some time to determine their impact on services for patients. The majority of patients present within the proposed new opening hours and arrangements are being made to ensure repeat visits take place within these hours or are accommodated elsewhere where this is not possible. The review will examine the impact of the decision and the difficulties which have arisen. These issues will be addressed by the HSE.