Written answers

Tuesday, 25 November 2008

Department of Health and Children

Hospital Services

10:00 pm

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 87: To ask the Minister for Health and Children if she has received a report from the Health Service Executive on contingency plans for the removal of all acute inpatient services from Monaghan General Hospital as confirmed to a meeting of staff on 23 October 2008; if she will intervene to reverse this plan which will remove this health facility for the people of County Monaghan and place pressure on staff and patients at Cavan General Hospital; and if she will make a statement on the matter. [42459/08]

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I am aware of the initiatives being taken by the Health Service Executive (HSE) to reconfigure hospital services across the Cavan/Monaghan Hospital Group and in the North East Region generally in order to improve safety and standards of care for patients. I understand that as part of the implementation process senior HSE management briefed staff at Monaghan Hospital along with union and staff representative bodies on the intended changes on 23rd and 24th October last.

The HSE has previously indicated that it plans to transfer acute in-patient services from Monaghan to Cavan and to develop additional services at Monaghan. It is working to ensure that the changes planned are introduced in a structured manner. This requires that specific measures are put in place and bedded down prior to, or in parallel with, the planned transfer of acute care to Cavan General Hospital. In particular it is necessary to establish a Medical Assessment Unit (MAU) at Cavan to help manage an anticipated increase in activity arising from the transfer of acute care. Enhancements in pre-hospital care in the Cavan/Monaghan area are also required, including the development of an enhanced ambulance and pre-hospital thrombolysis service. Alternatives to acute inpatient care are required through the provision of additional packages of care in the Cavan/Monaghan community care area.

A proposed date of 30th November 2008 for the transfer of acute medical care from Monaghan was subject to a number of these dependencies being in place, in particular the establishment of an MAU at Cavan and the development of an enhanced ambulance and pre-hospital thrombolysis service. The HSE now expects these developments to be in place in December 2008 and on that basis it now intends the change-over to take place two months after the Medical Assessment Unit opens. This will remain under review and the transfer will be announced in due course once these key elements have been delivered.

The existing Medical Wards at Monaghan General Hospital will in the future provide rehabilitation and step down services. There will be 26 such beds including 13 for rehabilitation and 13 beds for step down care. This will be in addition to day surgery, outpatient and minor injury services.

Photo of Jim O'KeeffeJim O'Keeffe (Cork South West, Fine Gael)
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Question 89: To ask the Minister for Health and Children the reason the regional orthopaedic unit for the north east is to close; the duration for which it will close; the number of patient procedures that will be affected by the withdrawal of this service; the number of these patients who will end up on National Treatment Purchase Fund treatment lists; and if she will make a statement on the matter. [42502/08]

Photo of Ruairi QuinnRuairi Quinn (Dublin South East, Labour)
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Question 103: To ask the Minister for Health and Children her views on the closure of wards and services, such as the orthopaedic services in Navan, due to budget shortages; her views on transferring funds from the National Treatment Purchase Fund in order to allow such services to continue where staff are already in place and being paid rather than have the same procedures carried out elsewhere at a higher unit cost; and if she will make a statement on the matter. [42447/08]

Photo of Arthur MorganArthur Morgan (Louth, Sinn Fein)
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Question 121: To ask the Minister for Health and Children if she will intervene to restore services at the north-east regional orthopaedic unit at Our Lady's Hospital, Navan; and if she will make a statement on the matter. [42461/08]

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 89, 103 and 121 together.

The Health Service Executive (HSE) indicated earlier this year that it was reviewing the need for cost containment measures to year end to ensure that expenditure across the Louth/Meath Hospital group, including Our Lady's Hospital, Navan, is managed within the approved budget. The HSE indicated that savings would need to be achieved in a number of areas including overtime, on call, agency and locum costs and that it may be necessary to reduce elective activity.

The HSE has been working to maintain elective orthopaedic services as far as possible and funding was reprioritised in this context. Hospital staff were advised by the HSE that with effect from week commencing 6th October 2008 the orthopaedic theatres in the Hospital would not be in use on Wednesdays and Fridays. In addition, as in previous years the Orthopaedic Department was due to close from 12th December 2008 to 31st December 2008. The HSE considered that the revised budget was sufficient to treat those patients already listed for the current year and to allow for additional priority cases to be treated.

Approximately 250 patients had procedures completed in the Orthopaedic Unit between September and 14th November. This level of activity was higher than anticipated and accordingly the HSE has decided that the Unit should close until the 5th of January. Those patients who remain on the treatment schedule will be advised of new treatment dates. The HSE's main focus is to protect emergency work at the Hospital and to ensure that the quality of emergency and other services that are provided is not compromised. Consultants have the opportunity during this period to address outpatient department waiting lists. The HSE has advised that it is not expected that the waiting lists for adult elective in-patient orthopaedic procedures in the North East will breach the national target limit of 6 months.

The National Treatment Purchase Fund (NTPF) is funded from the Vote for my Department. The Fund receives an annual allocation from which it arranges a quantum of in-patient treatments and out-patient appointments for the year, in line with an agreed service plan. The Fund is obliged to adhere to a direction from me to source at least 90% of the treatments it arranges in the private hospital system. The NTPF may purchase a maximum of 10% of its overall capacity from the public hospital system where this does not adversely affect core services. The purchasing of such capacity is necessary in order not to exclude patients whose surgical needs are best met within the public hospital system. There is no provision for the NTPF to transfer funds to the HSE on any other basis.

It has been possible to increase the allocation to the NTPF every year since its inception in 2002 and the numbers of persons who have benefited from the Fund have also risen. From an allocation of €5m in 2002, to €100 million in 2008, the total to date now amounts to €413 million. In 2002, the Fund treated less than 2000 patients. Early in 2008, it reached the milestone of its 100,000th client. This figure represented a combination of approximately 78,000 in-patients and 22,000 out-patients. In 2008, it is planned that 37,000 public patients will benefit under the Fund.

The NTPF has assured my Department that one of its core principles is to secure value for money. The prices paid by the Fund are influenced by factors such as prevailing insurance prices, capacity availability, complexity requirements and geographic considerations. The NTPF negotiates overall prices for procedures with individual private hospitals which includes pre and post operative consults, consultant fees and hospital costs, etc. Reference points used by the NTPF in compiling prices are public hospital casemix costs, estimated insurers' prices, consultant fees and prices proposed by peer hospitals.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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Question 90: To ask the Minister for Health and Children the steps being taken to implement the decision of 26 July 2008 on the reconfiguration of services at Roscommon County Hospital and Portiuncula Hospital, Ballinasloe, County Galway; and if she will make a statement on the matter. [42172/08]

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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Question 130: To ask the Minister for Health and Children her plans for the development of services at Portiuncula Hospital, County Galway; and if she will make a statement on the matter. [42170/08]

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 90 and 130 together.

The Government is committed to ensuring the delivery of the best quality health services possible, in an effective and efficient way. Ensuring patient safety is of paramount importance, so that people can have confidence in the services and that the best possible patient outcomes can be achieved. It is essential that we prioritise patient safety and quality and that we organise and manage services accordingly. The priority is to provide safe services as close as possible to where people live.

In the past, Roscommon County Hospital and Portiuncula Hospital Ballinasloe have operated independently, with two consultant general surgeons in each hospital. The difficulties faced by Roscommon and Portiuncula in maintaining surgical services independently, and the need for closer co-operation between them, were highlighted by the former Comhairle na nOspidéal in March 2006. Advances in clinical care and ever-increasing levels of specialisation mean that the present model of care faces important practical difficulties, which must be addressed. In the light of these factors, the best way of retaining and developing services at Roscommon and Portiuncula hospitals is for these hospitals to work closely together.

The Health Service Executive has advised that it is proceeding with the proposal for a Joint Department of Surgery and Anaesthesia at Roscommon County Hospital and Portiuncula Hospital, Ballinasloe. My Department has requested the Parliamentary Affairs Division of the Executive to arrange to have the detailed information sought provided directly to theDeputy.

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