Seanad debates

Wednesday, 4 October 2017

Commencement Matters

Hospital Services

10:30 am

Photo of Michelle MulherinMichelle Mulherin (Fine Gael)
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My Commencement matter arises out of the difficulty that oncology patients in counties Mayo, Roscommon, Sligo and Donegal have in accessing the designated centre of excellence at University Hospital Galway. I acknowledge the great work and dedication of the health care professionals in this centre of excellence, as well as those who work in the various other hospitals under the oncology speciality, often in difficult circumstances. The problem is not their work but patients being able to access the centre of excellence in Galway when they need to.

Recently, I received a communication from the Saolta hospital group telling me that quite a number of people in different Saolta hospitals are waiting to access the urology speciality at University Hospital Galway. Some of these are oncology patients. This matter arose because I was making a representation on behalf of an elderly man who is in Mayo General Hospital but who needs to access both urology and oncology treatments. He has been in Mayo General Hospital for the past two weeks because there are no available beds in University Hospital Galway, the only hospital where urology services are available. This situation arises again and again. Many people will not speak up or have me speak up on their behalf because they are afraid it will affect their treatment. I know it will not.

What is happening is that sick cancer patients are admitted to hospital, Mayo General Hospital in the case of the elderly man I know, where they hold up a bed when nothing can be done for them but just to keep them comfortable. The only solution they have is to present themselves at the emergency department at University Hospital Galway. I do not need to tell the Minister of State that there were 41 people on hospital trolleys there yesterday. Once they are kept on trolleys, most of these people would not be in a great medical condition. It is not good for a centre of excellence that the only way somebody might get treatment or a diagnosis is by going to the emergency department. This has been going on for years. Nine years ago, a family member of mine was in a similar position. They would not leave their hospital bed because, if they got sick again, they would have to go through the emergency department. Not only is cancer a debilitating illness, when one is getting radiology treatment, but one is in no fit state to be hanging around an emergency department.

This is a serious matter. If we are committed to the provision of a centre of excellence, we have to ensure that there are additional beds if cancer patients require them. We must also ensure that when cancer patients need to come back into the centre because of an infection, they should not be thrown into the emergency department. I know of one case where a woman from Mayo attended University Hospital Galway at 11 a.m. but, when I inquired later, she still had not got a bed in the evening. I do not think this is good enough. If I raise this for a particular patient, then something might become available. I am also told about clinical priority. However, when one is dealing with people who are ill, the notion of clinical priority is a bit of a fudge. There is no capacity. What about people in Donegal and Sligo in the Saolta hospital group? This is an expansive geographical area.

Is this the best way we can use beds? I have a note from the Saolta group stating that there are people in various hospitals waiting to get into Galway. Obviously, they are holding beds in those other hospitals.

What about those cancer patients who are not in hospital, do not have an infection but are waiting to get into Galway hospital?Those people also exist. The particular gentleman for whom I have been making representations was discharged from Mayo University Hospital this morning. It was his choice to leave. He still needs to get into University Hospital Galway. The man is seriously ill. Will something be done here? Can we deal with seriously ill cancer patients in a different fashion with regard to University Hospital Galway and what is going on at the moment and which has been going on for the past ten years at least?

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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I thank Senator Mulherin for raising this very important issue which is clearly one about which she is very passionate and concerned. University Hospital Galway, UHG, is the designated cancer centre in the Saolta university healthcare group and provides specialist oncology services, treatment planning and surgery for patients with cancer. Other hospitals within the Saolta group also provide some cancer services under the direction of UHG. For example, medical oncology services are available in Sligo University Hospital, Letterkenny University Hospital, Mayo University Hospital and Portiuncula University Hospital, Ballinasloe.

The Letterkenny breast cancer service operates as a satellite of the symptomatic breast disease service in UHG. This arrangement was made in recognition of the particular and unique geographical circumstances applying to Donegal. All treatment is carried out to the same high standard as care provided in UHG and is planned in collaboration with clinicians in UHG.

The Saolta group has informed me that as of yesterday there were three patients in Mayo University Hospital awaiting transfer to UHG. On a daily basis, patients for transfer, together with patients awaiting treatment, are clinically prioritised by the treating consultant. There were no patients awaiting transfer from the other Saolta hospitals.

Following the establishment of the national cancer control programme in 2007, symptomatic breast disease clinics and rapid access clinics for lung and prostate cancer were established in each of the designated cancer centres, including UHG. Patients with symptoms suggestive of breast, lung or prostate cancer are referred to these clinics for diagnostic tests.

There are specific targets set for each of these clinics. To date in 2017, the rapid access and symptomatic breast disease clinics in UHG have performed very well. The symptomatic breast disease clinic has exceeded the target, with 97.5% of patients triaged as urgent being seen within ten working days. The rapid access prostate clinic has also exceeded the target, with 98.9% of patients referred to the clinic being seen within 20 working days. Some 91.7% of patients referred to the rapid access lung clinic were seen within ten working days, falling just short of the 95% target.

It must be acknowledged that the symptomatic breast disease clinic in Letterkenny University Hospital has struggled to meet the key performance indicators recently. However, the Saolta university healthcare group has been working closely with the hospital to improve performance. In July this year, a locum breast surgeon was appointed, and this is expected to improve performance in the coming months.

UHG also provides radiation oncology services for the region. To date in 2017, 89% of patients who were referred to the radiation oncology service in Galway were offered an appointment within 15 days. As of November 2016, patients from Donegal can also be referred to the north-west cancer centre at Altnagelvin Area Hospital in Derry for their radiation therapy. This is a hugely important development as it ensures that patients can receive treatment as close to home as possible.

University Hospital Galway provides a range of high-quality oncology services, including diagnostic, surgical, medical and radiation oncology services. UHG also provides specialist cancer services for other hospitals in the Saolta university healthcare group. I assure the Senator that the HSE is committed to the continued provision of high-quality, timely services for patients with cancer under the care of hospitals in the Saolta university healthcare group. Saolta has assured the Department of Health that patients awaiting transfer, together with patients awaiting treatment, are clinically prioritised by the treating consultant.

Photo of Michelle MulherinMichelle Mulherin (Fine Gael)
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I thank the Minister of State. I understand full well the range of services and treatments which are supported in the other hospitals which work in conjunction with the centre of excellence. I am speaking about people who need to get into University Hospital Galway. I have given the Minister of State an example of such a case - a man who was waiting two weeks and who was told that he should try going to the emergency department in University Hospital Galway. As I have said, there are 41 people on trolleys in that hospital. No one will convince me that there is not a capacity issue in the centre of excellence in Galway. It needs to be addressed.

There was one point which the Minister of State did not address. Why should oncology patients who are discharged and who develop an infection be left to languish on a trolley in the same way as everybody else? There is no fast track if someone leaves and has to return. People are not leaving beds, and perhaps sometimes they could. They will not leave beds because of the manner in which they will be dealt with if they get sick again. They are, quite frankly, not up to it.

What am I supposed to say to the family of this gentleman? They have been clearly told that nothing can be done for him in Castlebar. He needs to see a urologist and he has now been waiting for 15 days. There is still no news for him. What am I supposed to tell him? It is not acceptable.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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With regard to the specific family, I am obviously not familiar with the case and I cannot speak on it. If the Senator wants to send me the details, I have no problem asking the HSE to furnish me with the details and an update on the situation on her behalf. Otherwise, as the Senator will appreciate, I am unable to comment on specifics, both because I do not know the detail and because it is not appropriate for me to comment on individual cases. If the Senator sends the details on to me, I am quite happy to find out how that system is working. The best way for me to figure out how a system is working is to look at an individual example. If there is a problem, I will have it investigated in full and will come back to the Senator on it. I invite the Senator to send me those details.

Photo of Michelle MulherinMichelle Mulherin (Fine Gael)
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I have sent them to the Minister for Health and to the chief executive of Saolta.

Photo of Paul CoghlanPaul Coghlan (Fine Gael)
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I am sorry, I cannot allow further discussion. I thank the Minister of State and the Senator.