Dáil Éireann debate -
Wednesday, 15 Oct 2003

Vol. 572 No. 4

Adjournment Debate. - Hospital Services.

Mr. Durkan

I thank the Ceann Comhairle for affording Deputy Gogarty and I the opportunity to raise this matter on the Adjournment. Peamount Hospital has given excellent service for many years in the area of services for TB and respiratory problems. It established a catchment area from the 1950s onwards. It is ironic that at this time a change has taken place and we hear talk of a new strategy for Peamount. I am always suspicious whenever I hear about new strategies. Being a medical practitioner himself, the Ceann Comhairle must have a view on this.

There is a new proposal to change the emphasis and to provide a hospital rehabilitation section. I have no difficulties with that. It is an admirable proposal, but for a variety of reasons it should not happen at the expense of the existing and established services in Peamount Hospital. Despite the information provided in tabular form by the Department, tuberculosis is still with us and is a serious illness. The Minister of State at the Department of Transport, Deputy McDaid, may find that out. I do not wish to challenge his medical view, but there comes a time when all lay people have the right to challenge the medical view, and may be right.

I want to register the total opposition of all the people in the catchment area to this proposal to dismantle Peamount and introduce what is termed a transitional phase. When I hear about a transitional phase, I get worried, because transition is usually something that is coming to an end in so far as the provision of service is concerned.

I have heard for many years that big is beautiful and that centres of excellence are the order of the day. In a report issued today, one reads of the benefits of the centres of excellence. What is proposed for the hospital in which we already have a centre of excellence? We propose to close it down and replace it with something else. This is extraordinary. It flies in the face of the Hanly report which has just been published.

It is not logical to do what is now proposed. I reject entirely the strategy behind the proposal. If some people think that ordinary Deputies might not know anything about the issue, I served 19 years on a health board, where we examined minutely every report produced. I call on the Minister for Health and Children, Deputy Martin, to use his influence to reverse the proposal.

Mr. Gogarty

The Minister of State at the Department of Health and Children, Deputy Brian Lenihan, is aware of the five year strategy. I broadly welcome it, but there is one item missing, a chest hospital along with related community care for the elderly in the catchment area.

Why are these services being dropped? It does not make sense. It is stated on page 21 of the Peamount strategy document that a chest hospital option was examined. If the time and money were spent examining the option, what case was given for leaving it out? No justification is given for breaking up and scattering the expertise. There is indeed a new centre of excellence in the pipeline for St. James's Hospital, but this is for acute patients, a term not fully explained, not for the vast majority of clients currently treated at Peamount for TB and other respiratory disorders, nor for the elderly residents from Brittas, Newcastle, Saggart, Rathcoole, Lucan and beyond, into north Kildare. Where will they go and what plans are in place for them? Solutions might be found in the future, but if the hospitals are working now, why change a winning formula?

It seems that the board of management is not for turning. The chief executive and chairman have admitted that the process in developing the strategy was flawed. The board seems to have collectively acted incompetently, and members were misinformed as to the board's extensive powers to retain the chest hospital in spite of recommendations from Comhairle na nOspidéal. A false impression was given that what Comhairle proposed is binding.

Two weeks ago I, together with community representatives, met the board's chief executive and chairman. Some assurances were given for the future, including that of community representation on the board and the possibility of changing the charter to allow staff representation. The chairman indicated that if the Minister for Health and Children, Deputy Martin, or even the EHRA, asked for the chest hospital option, the board would have no objection. It could however have taken a pro-active approach. I asked the chief executive to do so. He said that the board had already met. It seems the chief executive was more interested in the primary role of selling off land for housing than acting in everyone's best interests. I found it disturbing that he was not willing to call a board meeting to review the situation in the light of new information, and representation from the community and local representatives who raised concerns on behalf of hardworking and vastly experienced staff.

The strategy was flawed because the consultants' report was flawed, as was the information-gathering. A staff member complained about inadequate consultation, as did the wider community. There was minimal consultation with staff. The final consultants' report did not have any staff recommendations. No nursing input was sought or given nor was input sought from the multi-disclipinary team. All this expertise was ignored. The Minister must take a hands-on approach to direct the board or the EHRA to review the Peamount strategy and retain the chest hospital. As Deputy Durkan said, Peamount is the perfect location for the control of TB and non-acute respiratory conditions. It has spacious grounds in which people can get plenty of fresh air, all suited to the control of chronic disorders, unlike St. James's Hospital. Given that TB is on the rise, spreading patients throughout hospitals around the country will increase the risk. Peamount is one of the few hospitals in the country which is working. If it is not broken, why fix it? Let us make positive proposals with the other good recommendations in the strategy for the retention of the chest hospital.

Minister of State at the Department of Health and Children (Mr. B. Lenihan)

On behalf of my colleague, the Minister for Health and Children, Deputy Martin, I welcome the opportunity to clarify the position on the issues raised by the Deputies. The Minister gave a comprehensive reply to Deputy Durkan on 9 October in response to questions raised with regard to the future provision of tuberculosis and respiratory services at Peamount Hospital.

In July 2000 Comhairle na nOspidéal made a number of recommendations on the future organisation and delivery of respiratory and tuberculosis services. It recognised the valuable role which Peamount Hospital had played for many years. However, in line with major advances in medical treatment, it recommended that the optimal in-patient care of patients with respiratory diseases, including tuberculosis, was more appropriate to local acute general hospitals, staffed by consultant respiratory physicians and other consultants supported by an array of investigative facilities. Peamount Hospital was not regarded by Comhairle na nOspidéal as an appropriate location for the treatment of TB patients. Comhairle na nOspidéal has considerably more scientific knowledge of these matters than Deputies Durkan or Gogarty.

Mr. Gogarty

It does not have more knowledge than the staff of Peamount Hospital.

Mr. B. Lenihan

There is a very sad outlook for the future of the Hanly report and the health of patients in the greater Dublin area if Deputies are to continue to indulge in this type of parish pumping.

Mr. Durkan

The Minister of State should be ashamed of himself in making such a statement.

An Ceann Comhairle

Will the Deputy, please, allow the Minister of State to continue without interruption?

Mr. Durkan

He should know more about the area.

An Ceann Comhairle

The Minister of State has only five minutes in which to reply.

Mr. Durkan

He is giving a spoof reply and standing over a decision that should not be stood over.

An Ceann Comhairle

The Deputy was allowed to make his contribution without interruption. Will he, please, allow the Minister of State to continue?

Mr. Durkan

I am sorry, he upset me.

Mr. B. Lenihan

The Hanly report recommends the establishment of centres of excellence.

Mr. Durkan

Yes, and the Minister wants to close them down.

Mr. B. Lenihan

We have a scientific body composed of eminent medical men and women telling us what the centres of excellence should be. Unfortunately, Deputies want to indulge in parish pumping. There have been far too many of them in the House during the years – like facts, like cats, like water.

Mr. Durkan

That is a slash and burn policy.

Mr. Gogarty

That is a huge insult to the staff who are the experts in this area.

Mr. B. Lenihan

Comhairle na nOspidéal subsequently appointed a committee to advance implementation of the 2000 report which endorsed the recommendations in the earlier Comhairle report and was adopted by Comhairle in April 2003. Specifically, the committee recommended that Peamount Hospital play an active role in the provision of a range of non-acute support services, including pulmonary rehabilitation, within the South-Western Area Health Board. For example, it recommended that patients having been treated in the nearby St James's Hospital and other major acute hospitals and who required ongoing rehabilitative care could be transferred to Peamount Hospital for completion of their care.

The Minister understands that, in addition to the Comhairle na nOspidéal advice on this issue, the board of Peamount Hospital has developed a strategic plan for its development over the next five years. The hospital employed external support to assist it in this process and advise on developments in the wider health care environment. The strategy adopted by the board proposes considerable enhancement of existing services and development of new services in the areas of rehabilitation and continuing care of older people, persons with intellectual disabilities and adults with neurological or pulmonary illness. The implications for the acute respiratory services currently provided at the hospital are being assessed following which it is understood there will be further consultation with a range of relevant parties. The Eastern Regional Health Authority will participate fully in this process to ensure the interests of, and potential benefits to, patients of the region are fully realised.

Mr. Durkan

This is a sad day for medicine.

Mr. B. Lenihan

It will be a sad day if the Deputy continues in that manner.

Mr. Durkan

I am surprised at the Minister of State letting people down in that way.

An Ceann Comhairle

The Deputy's colleague, Deputy Neville, wishes to make his contribution.

Mr. Durkan

I am sorry, the Minister of State upset me.

Mr. Gogarty

The Minister of State has upset many.