Dáil Éireann debate -
Wednesday, 1 Jul 1992

Vol. 421 No. 9

Adjournment Debate. - Use of Cork Regional Hospital Pathology Services.

Mr. Allen

Will the Minister for Health make a statement on the investigations he has carried out into the commercial working arrangement between the staff members of the Southern Health Board working in the Cork Regional Hospital and the Shandon Drug Research Clinic? This working relationship of an informal nature came to light as a result of questions tabled by me to the Southern Health Board earlier this year. In reply to questions put by me, the senior management of the Southern Health Board stated they were unaware of any such arrangement in operation in Cork Regional Hospital. In my opinion the senior management of the Southern Health Board showed a lack of commitment to investigate the contents of my question in any realistic way and indicated in a written report to members of the board that they were unaware of any formal arrangement between the Shandon Drug Research Clinic and the Cork Regional Hospital. I put a supplementary oral question at a board meeting asking if they were aware of any informal arrangement but they answered in the negative.

At my insistence the health board carried out an investigation as a result of my question and discovered that senior staff members of Cork Regional Hospital were engaged in operating a business with the Shandon Drug Research Clinic, whereby subjects from the clinic were brought to Cork Regional Hospital and underwent tests on a regular basis. Needless to say this practice was continuing at a time when there were massive cutbacks in the services which were being offered to the public at Cork Regional Hospital. People had to wait up to two years for preliminary assessment appointments and in some cases they had to wait for over two years for surgery. In addition Cork Regional Hospital closed 63 beds this week, Bantry hospital have closed 30 beds, the Orthopaedic Hospital in Cork have closed 28 beds and Tralee Hospital have closed 45 beds, making a total of 166 beds which have been taken out of the system for the summer months. Against this background, individuals within the health services were making substantial amounts of money from their arrangement which involved using health board resources.

I ask the Minister to set out clearly tonight what he proposes to do about the situation. It is not good enough for the Minister to say that, in accordance with the common contract, individuals have the right to carry on in such a manner. It is highly offensive to me and to many others to see staff who are already well paid making huge amounts of money on an annual basis from arrangements such as this. Let me add that this is not the first time that such an arrangement has arisen in Cork Regional Hospital. I am aware of other situations and I find it difficult to accept that senior management of the health board were unaware that this was happening especially as new management structures were put in place there more than 12 months ago, under which structures a hospital manager and four assistant managers were appointed. Despite the new appointments which strengthened the management structures, this arrangement carried on without detection until it was raised by means of two questions asked by me.

Tonight I ask the Minister to set out clearly what he proposes to do now that he has received the report. Would he please identify the people involved; the money made by those individuals from the Shandon Clinic; the way in which he proposes to recover the money, which money belongs to the taxpayer; and the steps he proposes to take to ensure that the revenue lost to the Southern Health Board is recovered? There is no point in skirting around the problem. The people who suffer inconvenience week in and week out, people on a long waiting list, are entitled to know the outcome of the Minister's deliberations.

Minister for Health (Dr. O'Connell)

I should first like to apologise to Deputy Allen who raised this matter last week. On my way in to the Chamber I was waylaid and consequently, arrived too late to take the debate? The Deputy was most gracious about the delay and I pay tribute to him for that.

I have listened with considerable interest to Deputy Allen's contribution and I hope I can reassure him on this matter.

Some members of the Southern Health Board, as the Deputy will be aware, raised this issue last March, requesting a report on work being carried out by the laboratory at Cork Regional Hospital on behalf of the Shandon Clinic. The Deputy will also be aware that the Southern Health Board had the matter examined and very shortly afterwards received a report at their meeting on 6 April from the acting chief executive of the board. I requested and received a copy of this report and I also asked to be advised as to what action was taken on the matter.

The acting chief executive clarified for the board that a private commercial clinic had been submitting specimens to the laboratory at the regional hospital since early 1990. However, it will be appreciated that specimens are received by the hospital from a very wide range of sources. These are: in-patients of the regional hospital; out-patients of the hospital; general practitioners; other southern health board hospitals; public voluntary hospitals in Cork city; private hospitals in the city; and private commercial clinics.

In respect of the work carried out for the Shandon Clinic by the laboratory, it was not made known to the management of the regional hospital that this work was being undertaken for the clinic by staff of the hospital. The former general manager, having being informed of this practice, at once instructed the individuals concerned to stop all work for the clinic while hospital management discussed the situation with the clinic. The clinic themselves were also informed that the work done on their behalf was being halted.

Subsequently, the management of Cork Regional Hospital, having met representatives of the clinic told that latter that the hospital would carry out work for the clinic provided that (a) payment should be received by the hospital, not consultants, for work carried out to date, and (b) agreement should be reached between both parties on a scale of charges for future work.

The clinic were presented by the hospital with a bill for work carried out already. However, no agreement has yet been reached between these parties on the hospital's demands, and negotiations are continuing. In the meantime, the general manager's direction to laboratory staff to discontinue providing a service for the Shandon Clinic remains in place.

I am aware that the Deputy raised questions at the 2 March meeting of the health board regarding the bills issued by the pathologists at Cork Regional Hospital. The position is that the stationery, postage, collection and telephone costs in respect of the private fees are not carried by the hospital. Also, clerical/technical staff are not collecting those fees for the consultants. A rent is paid to the regional hospital by the consultants for office use in relation to fee collection.

I have been informed that the hospital, which now have a strengthened senior management team, have put in place sufficient controls to ensure that they are aware of all pathology work carried out from sources internal and external to the hospitals.

The common contract subject to certain conditions allows public hospital facilities to be used by consultants in respect of their private patients. However, I believe that the management of public hospitals can and should negotiate at local level with companies or other organisations who wish to use facilities so that a return is provided for the public hospital.

It is accepted that our laboratories are staffed by professionals of the highest quality and equipped to very high standards. It is critical that these resources be utilised to their optimum for the benefit of patient care. I propose to ensure that hospital management are encouraged and supported in every way possible to achieve this. The Hospital Value For Money Steering Group, which is chaired by an assistant secretary from my Department, have identified the management of pathology services in our major hospitals as an issue to be addressed this year. In a value for money context my Department are working closely with the chief executive officers and senior laboratory staff of five of our major acute hospitals, including Cork Regional Hospital, and as recently as 28 May last held a very constructive one-day seminar with representatives of the hospitals concerned.

The cost of laboratory services is growing from year to year and we are now at a stage at which laboratory costs can amount to up to 12 per cent of in-patient costs in our major hospitals. There are many reasons for this, for example, increased reliance on test results, increased turnover of patients, etc. I am convinced that while our laboratories make a very significant contribution to patient care it is absolutely necessary that the best return is achieved from their work, including maximising all income possibilities. To achieve this we must improve our information on workloads, outputs and costings and make the efficacy of our laboratory services more transparent than it is at present. I have no doubt that the necessary support and co-operation will be forthcoming from the hospitals and, in particular, from laboratory staff so that we can provide the best service to our patients.

While there is a need to maximise the potential for income in laboratories, I am also placing particular emphasis this year on the need for agencies to pursue all possible income generation initiatives so that we can maximise the resources available for patient care. The pursuit of all possible value for money initiatives, including income generation, is vital if we are to maintain services and standards in our hospitals; this, of course, must be balanced with the requirements of patient care, which must always be the main priority of the health services.

Obviously, to maximise the income generation opportunities, agencies will have to rely on the support and co-operation of all staff. It is very important that staff are fully informed of the policies, plans and procedures adopted at individual agency level and are encouraged by management to ensure that the resources of each agency are utilised to their full potential.

In conclusion, I want to re-emphasise that all agencies should now assess the potential for income generation in respect of services provided by them or that should be provided by them. My Department will be in contact with agencies on this matter shortly. I believe that the former position in Cork Regional Hospital regarding the use of laboratory resources by a small number of staff unknown to hospital management is something that must be avoided in the future. This can only be avoided when all health service staff are fully aware of and accept the management responsibility to follow up and implement all income opportunities so that quality services can be delivered to their patients.

Finally, I assure the Deputy that I will bring the points he has raised to the attention of my Department and that these points will be investigated.

Mr. Allen

Is it a sum of £50,000 that is involved?

Dr. O'Connell

The sum involved is of about that order.