Wednesday, 3 July 2013
I thank the Minister of State for coming to the House for this debate on the future of three community hospitals in County Donegal, in Stranorlar, Carndonagh and Dungloe. They are as geographically spread out as any three hospitals in the county could be. This issue, which affects every corner of County Donegal, was brought into focus recently when HIQA reports found that the hospitals in question were not 100% satisfactory. Many of these problems stem from the staffing of the hospitals. The communities served by these hospitals and the families of the hospitals' patients need to get some clarity. That would be better than certain individuals going on the airwaves to say that the hospitals will close, or that there will be a reduction in services. Older people would rather have clarity. Many of them would regard the community hospital in the same way as their sitting room or kitchen. That is where they spend their time and where their families visit them.
County Donegal may be unique in how its community hospital service is structured. Lifford Community Hospital, which is roughly in the same boat, provides a useful step-down service to those treated at Letterkenny General Hospital. The local community and the local doctors came together when that hospital was under threat to speak to the Minister and draw up a plan to help the hospital improve structurally. It has been suggested recently that the three hospitals I mentioned at the outset could lose beds and never get them back. Older people find it difficult to accept that possibility. A local councillor, Martin Farren, has attended some meetings about the future of Carndonagh Community Hospital. Another councillor, Frank McBrearty, has been dealing with St. Joseph's Community Hospital in Stranorlar. I have also spoken to people who have attended meetings in Dungloe.
The HSE has a communications problem. Its management should play a more proactive role and say exactly what is happening here. When rumours are spread about hospitals - this seems to be a regular occurrence - politicians from all parties have to find out what is happening and go on the airwaves to explain the position before someone from the HSE eventually issues a statement. The HSE should be more proactive in explaining what is actually happening to the public, the community and the patients in our community hospitals and thereby providing reassurance. The worst thing for a hospital is for a rumour to get legs. In such circumstances, everyone believes the rumours rather than the facts. Maybe that should be considered in the overall context of how the HSE communicates. These rumours should be nipped in the bud more quickly. Perhaps the Minister of State can provide some clarity on the future of these three hospitals.
I do not need to tell anyone in this country, and definitely not anyone involved in politics, that we are facing challenging times as we try to keep the finances, the services and the infrastructure of our community units in place. These challenges relate to finances, to staffing and to the ageing structures in which these units are housed. All developments have to be addressed in light of current economic and budgetary pressures. Any decisions taken by the HSE must have regard to these pressures and to the current recruitment moratorium.
The 11 community hospitals in County Donegal provide 400 public beds, of which 238 are short-stay beds and 162 are long-stay beds. They are supported by a wide range of community-based services. Primary care centres are attached to six units, which means there is access to services including public health nurse services, community psychiatric nursing, home help services and old age psychiatry. These services are available to residents of the units as need requires. The use of short-stay beds has enabled older people to access the services and supports they need to maximise their independence and remain at home for longer. This is demonstrated by the fact that just 2.7% of older people in County Donegal are in long-term care, compared to a figure of 4% nationally. There is an emphasis in the county on supporting acute services to discharge older people in a timely manner to step-down facilities in community hospitals. Some 976, or 29%, of the 3,353 admissions to community hospitals were from acute hospitals in 2012. The availability and use of short-stay beds in community hospitals minimises acute hospital admissions as it allows general practitioners to admit patients to community hospitals directly.
Dungloe Community Hospital, like Carndonagh and Stranorlar community hospitals, was registered with the Health Information and Quality Authority on 22 June 2012.
The registration period is three years and the current capacity is 35 beds. In addition to long-term care, there is a day hospital, outpatient clinics, X-ray and other specialist services. The hospital has recently experienced an increased number of staff retirements, long-term sick leave and maternity leave. In order to maintain a sate level of care to patients the HSE decided temporarily to reduce the number of short-stay beds by ten. Long-stay beds are unaffected. The decision to close the beds temporarily was taken to ensure that there is an adequate number of staff to meet all of the needs of the residents safely. The hospital will continue to provide respite and rehab care within its current capacity.
Carndonagh Community Hospital is the focal point for health care delivery in north Inishowen, delivering a comprehensive service to meet a wide range of patient needs. Services include long-term care, respite, rehabilitation, palliative and dementia-specific care. There is a wide catchment area with 14% of the population over 65, many of whom live in isolated areas and alone. This places greater demands on services, particularly inpatient services. The current bed capacity in Carndonagh Community Hospital is 38. The recent decision to reduce capacity from 42 to 38 beds was also taken to maintain safe and appropriate levels of care to patients. The situation will be kept under review and as sick leave resolves the beds will re-open.
The current capacity of St.Joseph's Community Hospital is 75 beds. Services include respite, rehabilitation, palliative and intermediate care and there are 27 beds available for long-term residential care. When the hospital was last inspected by HIQA in April 2013, inspectors observed that while staff provided care in a knowledgeable, competent and respectful manner, there was a concern that this complex mix of residents can make it more difficult for the staff to meet the needs of long-term residents. In order to address this issue one ward, with a dedicated staff, has now been designated for long-stay residents only. The changes mean St. Joseph's will now have an operational capacity of 67 beds. I am confident that this response will facilitate improved compliance with residential standards. Residents and their families can be assured that management and staff will continue to work to provide the highest standards of care in all the community hospitals in Donegal. The HSE has asked me to assure the House that the residents at all these facilities are receiving a safe and quality service. Bed capacity across community hospitals in Donegal will be kept under on-going review. However, there are no current plans to further reduce bed capacity. I hope this is of some help to the Senator.