Seanad debates

Wednesday, 15 May 2013

Adjournment Matters

Hospital Services

4:30 pm

Photo of David CullinaneDavid Cullinane (Sinn Fein)
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I welcome the Minister of State to the House. Yesterday, the long awaited Higgins report into the establishment of hospital groups in the State was published. As the Minister of State knows, six groups will be established and there will be consolidation of smaller and larger hospitals with academic links to universities. We can differ on whether the concept of groups or trusts is good or bad. I want to raise the concerns of many people in Waterford and the south east regarding what is being proposed.

Waterford Regional Hospital, it seems, will be renamed as Waterford university hospital and become a full teaching hospital. That proposal has its merits and attractions. As it stands, however, Waterford is serving five counties, namely, Waterford, Kilkenny, Carlow, Wexford and south Tipperary. It provides specialist services and tertiary care in areas such as cancer, neurology, renal services, ear, nose and throat, ophthalmology and a range of other services. Most of those specialties require a critical mass to justify their retention, which comes from the population base. In that context, there is a real concern at the prospect of two hospitals in the same region, St. Luke's General Hospital in Kilkenny and Wexford General Hospital, being assigned to an entirely different group or trust from the one to which Waterford Regional Hospital is assigned.

The Higgins report refers to a leakage of patients away from Waterford Regional Hospital to hospitals in Cork and Dublin. In fact, in a briefing last night, Professor Higgins alluded to 10% of patients from Wexford travelling to Dublin. In a situation where Waterford will be in one group with Cork, while Wexford and Kilkenny will be in an entirely different group, and those trusts will in time be competing for patients, how does the Government intend to secure the retention of existing services at Waterford? If the leakage of patients from the region to hospitals in Dublin or Cork continues, then there is a genuine and rational concern that this could, at some point in the future, be used as justification for downgrading services at Waterford. How can we guarantee that Waterford Regional Hospital, if it becomes a university hospital, will continue to function as a regional hospital and will retain all of the regional and tertiary services it currently provides? What guarantee can the Minister give in regard to these services and how can he fulfil that guarantee in actions as well as words?

We were told prior to the publication of the Higgins report that Waterford would be providing cardiology services on a 24-7 basis. This, in fact, was to be one of the carrots contained in the report. However, what the report actually refers to is enhanced cardiology services. Indeed, both the Minister and Professor Higgins were very clear when questioned last night that there is no commitment to the provision of that service at Waterford. Will the Minister of State clarify this issue? The current situation is that Waterford Regional Hospital is not providing a 24-7 cardiology service for the region as it should and must. If the Minister of State is in a position to confirm that this service will be introduced, what timeframe is envisaged for its establishment?

Professor Higgins has indicated that the decision not to recommend the retention of the south east as a region was the lack of shared vision or cohesion among the facilities there. Will the Minister of State indicate what shared vision there is between Mallow General Hospital, for example, and Waterford Regional Hospital? What shared vision is there between Mullingar, Wexford and Kilkenny? The argument regarding lack of cohesion is a red herring and I do not see how the Minister can justify these proposals on that basis. I am asking these questions out of a genuine concern, which is shared by many people in the region, regarding the retention of services at Waterford Regional Hospital.

4:40 pm

Photo of Alex WhiteAlex White (Dublin South, Labour)
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On behalf of the Minister, Deputy James Reilly, I thank the Senator for raising this matter, which provides an opportunity to discuss with the House the reports that were launched yesterday. As the Minister has said, these proposals signal a fundamental modernisation of our health system organisation in line with best practice. The objectives of the hospital groups are: to achieve the highest standard of quality and uniformity in hospital care across each group; deliver cost effective hospital care in a timely and sustainable manner; encourage and support clinical and managerial leaders; ensure high standards of governance, both clinical and corporate; and recruit and retain high-quality nurses, non-consultant hospital doctors, consultants, allied health professionals and administrators in all our hospitals. The introduction of groups will provide for organisational change in the first instance, offering more autonomy to providers and better enabling the reorganisation of services in a well-planned manner. Over time, this will help to improve services and deliver better outcomes for patients.

When it became clear in November 2012 that there might not be sufficient medical professional consensus and support for a stand-alone network or group in the south east, a further period of intensive discussions with the four acute hospitals took place. As a result, there is now a broad acknowledgement within the consultant establishment in those hospitals that the future development and prosperity of all four facilities is best served by accepting the proposal outlined in the Higgins report which places Waterford Regional Hospital and South Tipperary General Hospital, Clonmel in the south-south-west hospital group and Kilkenny and Wexford hospitals in the Dublin east group. Waterford will continue to be a cancer centre under the national cancer control programme. It will, in addition, be the hub for the south-east renal service and a regional trauma centre. It will also continue to provide invasive cardiology services for the population of the south east.

In addition, an undertaking was given that the Department and the Health Service Executive would work with University College Cork to enable Waterford hospital to become a university teaching hospital linked to UCC. Discussions with the university have also taken place and agreement reached in principle on developing closer links, leading in due course to parity status with Cork University Hospital. These discussions have been shared with the Royal College of Surgeons in Ireland, which has a strategic interest in Waterford Regional Hospital as a major undergraduate teaching campus for its students. In short, Waterford Regional Hospital is to become a fully recognised university teaching hospital linked to UCC, with all the privileges associated with that status. In furthering this proposal, UCC is committed to putting in place academic clinical appointments on an incremental basis at professorial, senior lecturer and tutor levels, with associated administrative support. Discussions within the new group's corporate governance structure and in turn with the HSE and the Department of Health will now commence to give effect to these changes.

The traditional practice of providing as many services as possible in every hospital is neither sustainable nor safe. Experience in Ireland and beyond informs us that a co-ordinated system of care is clearly better for patients than a more sporadic approach from hospital to hospital. I am confident that the formation of hospital groups will lead to safer, more effective and more efficient services for all patients. We are all agreed that the focus in all of this must be on what is best for patients. That is the starting point. We do not start from an existing hospital - I am speaking generally here, not specifically about Waterford - and look outward in terms of seeing how we can maintain or preserve everything that has always been available at that particular location. I appreciate that this is not the Senator's perspective, but it is important to state it. We must begin by considering how best to serve the needs of patients and organise care at the optimum level for all citizens. People are usually patients for a short period of time but they are citizens all the time. The focus must be on building the best possible services around the interests of the patient. From his contributions in the House, I know the Senator will share that perspective.

Several commentators, including the leader of the Senator's party in the other House, expressed concern yesterday about a lack of detail in the proposal. Once the groups are established, it will be a matter for each of them to examine some of the outstanding issues that need to be addressed in terms of the best configuration of care across the group. Those types of decisions will be left to the groups.

In terms of the specific issues the Senator raised, I have indicated that Waterford Regional Hospital will continue to be a cancer centre, a hub for the south-east renal service and a regional trauma centre. I also referred to the enhancement of the status of the hospital through its links with UCC. We would all agree that the teaching element of a modern hospital is vitally important. In fact, there would be questions to answer if a hospital as advanced and important as Waterford were left without a teaching dimension to its work.

That would be of concern to people, and that will not happen here. There will be professorial and teaching positions in this hospital, which will give it great strength and endurance. I have no doubt that Waterford Regional Hospital will endure to serve patients for a considerable period into the future.

4:50 pm

Photo of David CullinaneDavid Cullinane (Sinn Fein)
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Waterford Regional Hospital is a teaching hospital. What is being proposed is that it become a fully recognised university teaching hospital, and that has advantages. However, I have not received a reply to the core question from the Minister for Health, the Minister of State, Deputy White, or Professor Higgins. Following the establishment of these new groups, two hospitals in the region will be in a different group from the group of which Waterford Regional Hospital will be a part, which is the Cork group. What will happen in a situation where those trusts or groups will compete against each other? If we have a situation where there is a leakage of patients away from Waterford Regional Hospital towards hospitals in Dublin, and that will be a natural dynamic, can the Government continue to support services in Waterford Regional Hospital?

Of course the patient comes first, but we are trying to protect the status of Waterford Regional Hospital and the full complement of services in the region. History has shown that Ministers can give commitments, but the reality can be different. If over time there is, unfortunately, a further drift of patients away from Waterford Regional Hospital, there is a genuine fear this could be used as an opportunity to tell the hospital that as it does not have the critical mass, it cannot justify retaining certain services. That is the core fear of the people in the south east and I am anxious to impress that upon the Minister.

I welcome the clarifications given by the Minister of State. Given that this is very significant for acute hospital care and will have profound implications for acute care in the State for generations to come, it is important to tease out all the issues and seek clarifications so we will have the certainty and clarity we need.

Photo of Alex WhiteAlex White (Dublin South, Labour)
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I do not have much to add to what I have already said. I do not wish this to be interpreted as a rebuff in any sense to the Senator, but absolute guarantees for anything in the future are not attainable. There is no absolute way of looking into the future and knowing precisely how things will be five, ten or 15 years hence. The hospital in Waterford should, and does, have confidence that it will be a hugely important part of the delivery of health care in this country. Waterford is entitled to have that confidence for the future. However, nobody can have absolute certainty as to precisely what future patient movements or pathways will be, not just in the case of Waterford but with regard to anything we are doing in the reorganisation across the country. The way to deal with it, as the people in Waterford have dealt with it, is to put safeguards in place - in some cases one could call them guarantees - which means strong foundations that will be there into the future. They have been put in place and that is the guarantee, coupled with the sense of confidence and excellence that Waterford Regional Hospital will continue to provide. That is as close as one can get to guarantees.

The Seanad adjourned at 7.05 p.m. until 10.30 a.m. on Thursday, 16 May 2013.