Seanad debates
Wednesday, 5 October 2011
Hospital Accommodation
5:00 pm
Thomas Byrne (Fianna Fail)
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I thank the Cathaoirleach and the Leader for forcing the Minister for Health, Deputy James Reilly, to come before the House. We welcome the Minister today but it is a shame that I, after 15 votes in this Chamber calling on him to present himself, had to threaten to walk out this morning if he did not.
Denis O'Donovan (Fianna Fail)
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The Senator should speak to the Adjournment matter.
Thomas Byrne (Fianna Fail)
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That was not an unreasonable request; it was simply because he refused time and again to come to the House to talk about the issues of the day. His own colleagues were calling for this and we put the matter to a vote at least 15 times in this House. When I finally reached the end of my tether, I said I would withdraw from the House this evening if the Minister did not turn up. Other Ministers take the time to attend. I accept that a Minister will always have scheduling difficulties but when the Minister for Health did not appear, I had to make a stand. I thank my colleagues for being present today to support me because they also have issues in their constituencies that relate to the Minister which they would like to discuss. I know they will have an opportunity to do so.
On Monday there were 53 people on trolleys in Our Lady of Lourdes Hospital in Drogheda. Considerable investment was made in the hospital by the last Government. There is a huge extension that provides first-class services to people if it can hold the number of people who want to use those services. The Fianna Fáil Party and HSE were criticised, often justifiably, particularly by the current Minister, when there was a large number of people on trolleys, but in the last general election the Minister promised the sun, moon and stars. I was with him on a platform in Navan where he promised the people of Drogheda and the north east in general that change would happen. In September 2010, under a Fianna Fáil Government and an independent HSE board, 331 people spent time on trolleys in Our Lady of Lourdes Hospital. In September 2011, when the current Minister was in control of the HSE and after he had put his own officials on the board - I applaud him for taking control because it is important that the Minister have responsibility - 842 patients spent time on trolleys. This is scandalous. There has been an almost threefold increase in the number of people on trolleys.
What will the Minister do about this? Given that I accept that he cares about patients and I care about patients in my area, the circumstances that obtain must not be allowed to continue. I have had family members in the accident and emergency department in the hospital regularly. This is inevitable when one has three children and a wife who plays football. They have received an excellent service but the staff are under severe pressure. People's lives and well-being are being put at risk. Other parties have submitted complaints to HIQA on this. We await its response with trepidation because, if any action is taken against the accident and emergency department in Our Lady of Lourdes Hospital, I do not know where we would go in case of emergency.
When the Minister sacked the board of the Health Service Executive, it was supposed to be the start of something radical and fresh that would make the lives of people different. We asked at the time what the changing of the faces on the board would mean for the ordinary person. It means that the ordinary person in the north east who is using the emergency services in the hospital is now three times more likely to spend time on a trolley.
It is too serious an issue on which to stifle debate. The Government parties in this House have stifled debate on health services time and again. I have worked out that this has occurred in 15 cases. Senator O'Keeffe often talks about cancer services in Sligo, and rightly so, but every time we put these issues to a vote, nobody wants the Minister to come to the House to discuss them. While I am sorry I had to make my threat today, the Minister is welcome. I want to hear exactly what he will do about trolleys in the north east. We look forward to the improvements promised on foot of changing the board of the HSE. The new members are actually the Minister's staff and civil servants. The Minister is responsible; let us hear his answer.
James Reilly (Dublin North, Fine Gael)
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I am delighted to be here. It is a bit rich for the Senator to make the statements he makes considering that his Government, which was in power for 14 years, left the country broke. It threw money at the health service without ever trying to reform it. Consequently, we are in the mess we are in.
Thomas Byrne (Fianna Fail)
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The Minister opposed all the reforms we put in place.
James Reilly (Dublin North, Fine Gael)
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I did not interrupt the Senator. He has asked me to come here to talk to him so he might at least extend to me the courtesy of listening.
I stated previously that the waiting times for admission of patients attending emergency departments in many hospitals are unacceptable. I am determined to have this addressed. In this regard, we have established a special delivery unit and have assigned to it as a priority task the addressing of the issues arising in emergency departments. I have said on many occasions that, in respect of acute emergencies, one must start with the sickest people, namely, those waiting on trolleys in emergency departments, and then proceed to address the long waiting lists for inpatient treatment, after which one should tackle outpatient treatment.
The Senator must accept that one cannot turn a huge oil tanker like the health service around overnight. Years of dysfunctionality and mismanagement under successive Governments under the Senator's party's control have led us to the sad and sorry state we are in. Owing to our being left by the Fianna Fáil Government with a €70 million overrun in the hospitals and a wild overrun in the first three months of this year, with budgets way out of kilter, and our being in a financial morass, again left by the Fianna Fáil Government, we have to take nearly €1 billion from the health budget. On the back of these considerations, we must try to maintain a service and at the same time reform it. We are determined to do so and will do so. A special delivery unit is very important in this regard.
The clinical director and group general manager are fully engaged in the hospital in regard to scheduled and unscheduled care with the help of Dr. Martin Connor of the special delivery unit. In the short time he has been here, he has done something the Fianna Fáil Government never did, that is, shed some light on the matter and given us some information. Before now, we could not see what was happening in the hospitals. There were returns at the end of the year. We have put in place an information system that allows us to see and track patients daily in real time in our emergency departments. We can now track, in real time and on a weekly basis, the waiting list of each consultant. We can now do what we wanted to do. We can talk to people and hold them to account. If surgeon 1 has a waiting list of two months and surgeon 2 has a waiting list of two weeks, we will go down and have a little chat with surgeon 1. We will not send a cardiologist or administrator to talk to him but a surgeon. It is a case of like meeting like. We will help those concerned to address their problems, including through retraining, if necessary. If they are intransigent and refuse to change their ways, there will be consequences for them.
Our Lady of Lourdes Hospital is currently implementing a two-pronged approach to the overcrowding in the emergency department. First, it is working closely with the special delivery unit to improve capacity planning throughout the hospital. Second, it is actively engaged in the implementation of the HSE's national clinical care programmes, which will focus on extending hospitals' acute medical assessment unit facility.
Our Lady of Lourdes Hospital is operating a proactive, three-tiered response based on the level of overcrowding. In response to the numbers of patients who have presented at the emergency Department over the past week, the HSE has arranged additional theatre time in order to facilitate the treatment of additional surgical cases. Additional diagnostic capacity has been provided to allow the medical assessment unit to enable the provision of treatment and diagnostic capacity for ten spaces this morning for patients in the emergency department.
For the past week, the medical assessment unit and day ward have opened at night to accommodate the extra patients from the emergency department. The pathway of each patient is reviewed each morning by 8 a.m. and also at regular intervals throughout the day, particularly when the escalation policy to deal with this issue is in place. Additional ward rounds are also undertaken throughout the day and on-call physicians and surgeons are met to review their treatment plans for patients. Where blockages are identified, the hospital management engages with the relevant service to expedite the provision of this service to patients.
In the emergency department earlier today, there were 21 patients awaiting admission. When I rang at 4 p.m., there were 18. Further decreases in this number are expected during the course of the day.
While the issue of overcrowding and waiting times in emergency departments that are symptoms of broader hospital issues are a source of concern, it is important to note that when a patient comes into an emergency department, his treatment begins in accordance with the priorities identified by way of the triage process. Anyone requiring urgent care receives it.
Thomas Byrne (Fianna Fail)
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I thank the Minister for coming to the House. The Minister referred to years of mismanagement. The reality is the clinical director and the group general manager are, in practice, the same people in which he now has trust. They are the people I always had trust in when the Minister's party was undermining them personally on local radio interviews in recent years. Every time they made a decision in the best interests of patients the Fine Gael, Labour Party and Sinn Féin spokespersons came on to undermine these individuals and doctors publicly and privately. Now, while the Minister is ascribing years of mismanagement to our Government, the managers whom the HSE trusted to do the job are the same people the Minister now trusts to do the job. I believe they are the right people but the Minister is putting the emphasis on the special delivery unit, SDU. He stated the hospital is working with the SDU. Those in the hospital should be allowed to get on with the job, under supervision from the HSE, the board and the Minister. I am unsure what the addition of a Civil Service structure will bring to it but it seems this is the case and the facts speak for themselves: there are almost three times as many people on trolleys since the Minister took power.
James Reilly (Dublin North, Fine Gael)
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I reiterate that we must save €1 billion thanks to the economic mismanagement the Fianna Fáil Government engaged in. Against that background it is remarkably difficult to try to maintain the service and it is a challenge but it is one we are meeting. I will provide a flavour of how things are different with the special delivery unit. It is not what Senator Byrne describes at all. It is a key performance analytical machine that gives us the information to allow us to manage patients, the system and to identify where problems arise. We can discuss this hospital and other hospitals but we know there is a management deficit within the hospital system. Many excellent people were administrators promoted into management but they never got management skills or the training. The special delivery unit will help to support them and this is what it is there to do. We have no wish to get rid of managers or consultants who have a great deal of experience. We want to help them to change and get the skills they require to run our hospitals effectively.
I will finish with one point to demonstrate how things are different now. I asked the HSE how much money and how long would it take to put in place the information system we now have because I saw it working in Northern Ireland. I was told it could take 18 months and would probably cost €10 million. Dr. Martin Connor, people from inside the HSE, the Department and the NTPF have achieved this in 98 days at a cost of €250,000. This is the way forward, it is how we will change the way things are done in this country and it is why I have absolute faith in our people and our ability not only to fix our health service, but to fix our economy and to put ourselves back to our rightful place internationally and throughout the world.
Mary White (Fianna Fail)
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When does the Minister intend to roll out free breast cancer treatment to women over 65 years?
Pat O'Neill (Fine Gael)
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This is Adjournment Matters, not questions to the Minister.