Dáil Éireann debate -
Tuesday, 3 Feb 2004

Vol. 579 No. 1

Adjournment Debate.

Health Centres.

Ms Shortall

I thank the Minister for coming to the House at this late hour to respond to this matter. This is an important matter and it is very important to the people of Ballymun who are in the process of a major regeneration of their area. Ballymun is a significant town of approximately 15,000 people. As the Minister will be aware from the profile of the area, there is a very high social welfare dependency and a consequent very high health care dependency. There is only one health centre to cater for a town of 15,000 people which is unusual for most Irish towns of a similar size. That health centre was built many years ago at a time when the Ballymun estate was first developed. It is now completely inadequate and is a very dilapidated building in very poor condition. It is impossible for clients to attend in many cases and it is very off-putting. It is very difficult for the staff who work there. There is not enough room in the building for all the staff and this has been the case for the last few years. They are dotted around the northside in rented accommodation in Santry and Fairview. The situation is wholly unsatisfactory.

In light of the emphasis which the Minister is seeking to place on the important role of primary care, it is critical that should an area of high dependency like Ballymun, have good quality primary health care services available which are inviting and can accommodate the needs of the local area.

In 1998 the then Eastern Health Board identified Ballymun as an absolute priority area. The requirement to replace the existing health centre was identified and included in the Eastern Health Board's capital programme in 1998 and in every year since. A short while later Ballymun Regeneration Limited came up with a proposal to build a flagship centre on the main Ballymun Road. Anyone passing through the area will be familiar with that magnificent new building which has been completed since this time last year.

The agreement between the Northern Area Health Board and the ERHA which was entered into through the Minister's Department, was that the health board would take some 60% of that building in order to provide an adequately sized health centre for the whole town of Ballymun and to provide office accommodation for the area 7 headquarters of the health board. That agreement was entered into in 2000. Ballymun Regeneration Limited developed that proposal and brought it to fruition last year. The project was brought in on time and on budget.

There is great disappointment in Ballymun — on the part of the residents, the public representatives and the city council — at the fact that the health board and the Minister's Department have not delivered on their side of the bargain. That excellent and modern accommodation has been lying idle for the past 12 months. The rent has to be paid. It was built on a design, build and finance basis and rental purchase must be paid at approximately €3.5 million per year. The Minister is a year overdue with that payment.

Dublin City Council has been carrying that debt for the Minister since then and he will know that local authorities are not in a position to do that. As far as the council and I are concerned, the Minister's Department has welched on that agreement. The Minister was part of the deal and the cost of the project was always understood and there were no surprises for anybody. The project was completed on time but once it was completed, the Minister was not prepared to provide the money. He is not prepared to provide the money for the rental purchase but more critically, he has not been prepared to provide approximately €9 million which is required for fit out and furnishing of those premises.

The primary care health situation in Ballymun is at a critical stage. There are vacancies in many of the posts, particularly in the therapies such as public health nursing and social work. Very few children in Ballymun have developmental tests, for example.

An Ceann Comhairle

The Deputy's five minutes are concluded.

Ms Shortall

There are significant gaps in the primary health care system and it is primarily due to inadequate accommodation. That very good, modern accommodation is lying idle——

An Ceann Comhairle

Deputy, I ask you to give way to the Minister. In fairness to the staff of the House I request all Members, including Ministers, to confine themselves to the five minutes under Standing Orders.

Ms Shortall

——and I appeal to the Minister to provide the funding that he has promised and which he has welched on to date.

Minister for Health and Children (Mr. Martin)

I thank the Deputy for the opportunity to speak on this important matter.

The provision of health centres to meet the needs of local communities within its functional area is a matter for the relevant health board or the Eastern Regional Health Authority. In the case of Ballymun that responsibility rests with the Eastern Regional Health Authority and the Northern Area Health Board.

The authority has advised me that discussions involving the former Eastern Health Board and Dublin Corporation, regarding the provision of a new primary care centre with associated administration offices in Ballymun, date back to 1996. It was agreed by both these bodies that the health board should provide services from a central civic amenity building which was to be the centrepiece of the redevelopment of Ballymun town centre.

Ballymun Regeneration Limited, a wholly-owned subsidiary of Dublin City Council, established for the purpose of advancing the regeneration of the area in conjunction with the former Eastern Health Board, developed a brief for the civic centre which included provision for a primary care centre and the community care area 7 headquarters. I am further advised that following its establishment, the Northern Area Health Board, NAHB, continued to liaise with Ballymun Regeneration Limited on this project.

While the NAHB agreed in principle to become a major sub-tenant, it did so on the basis that it was made clear to Ballymun Regeneration Limited that its participation was subject to necessary approvals from the Eastern Regional Health Authority and the Department of Health and Children, and the making available of funds for the project.

The ERHA has confirmed that the construction stage of the development was completed in February 2003. The Northern Area Health Board's share of the floor space in the civic amenity building is approximately 60% of the total. The authority has further advised that the NAHB intends to acquire its share of the building on a lease-purchase basis over a 14-year period, at an annual cost of €4.02 million. The fit out of the NAHB's portion of the building, that is, building works, electrical, plumbing, painting and decoration, floor finishes, etc., has been estimated at €6.35 million and the provision of furniture and fittings has an additional estimated price tag of €2.8 million. It would take approximately eight months to complete the fit out.

The latest estimates provided by the ERHA would indicate a total funding requirement of in excess of €60 million for the provision of the facilities. The authority has advised that the proposed financing arrangement over the 14-year period will mean that the NAHB or its successors will own the relevant portion of the building after this period.

All health boards and agencies are required to follow the Department's guidance documentation for capital projects, together with national and EU capital procurement procedures. The availability of overall funding requirements is also a necessary prerequisite in informing decisions regarding proposals from health boards to proceed with capital developments. It is normal in the first instance for the health agency involved to submit to the Department project details for agreement such as assessment of need, option appraisal, design brief, cost estimates and cashflow projections.

The NAHB proceeded with this project with neither the involvement nor approval of the Department of Health and Children. The Department has requested information and requires clarifications from the ERHA and the NAHB on various aspects of this project, in particular those relating to the overall scope of the project, funding, procurement procedures and value for money. When this information is received the Department will complete its evaluation of the project in conjunction with the ERHA and area health board.

Ms Shortall

The Minister had that information for a long time. He should not put it on the long finger.

Irish Blood Transfusion Service.

Mr. Allen

I thank the Chair for giving me an opportunity to raise this issue tonight. The Irish Medicines Board has warned that the blood screening irradiator which helps to prevent serious complications, or even death, at the Irish Blood Transfusion Service unit in Cork is faulty. The machine, which prevents a rare but sometimes fatal reaction in some patients who receive blood is in such poor condition that the service has been forced to suspend some of its activities at its Cork facility. Blood not used in one hospital is recalled and sent to another. An inspection carried out by the IMB was critical of policy control at the Cork unit. The minutes of the IMB's December board meeting stated that "quality assurance is not sufficiently aware of the urgency and extent of product recall". The December minutes also noted that the board has "major concern regarding the potential for inadvertent reissuing of recalled product". A spokesperson said that the programme would be suspended until there is greater clarity in "recall procedure". This includes determining if blood has been stored at the correct temperature and handled properly in the hospital from which it came.

An article in The Examiner today quoted the Irish Medicines Board as saying that the risk assessment analysis of the irradiator will be completed shortly. The article by Catherine Shanahan mentioned that the board's inspection also found problems with the premises and equipment in Cork. It was reported that the post of senior technical officer has been vacant since August 2002 and the post of quality officer has been vacant since April 2003. Yesterday's IBTS statement said that the difficulty in filling positions was due to “uncertainty regarding the development of the facility”.

The Government promised a major new unit in Cork in the course of a by-election in Cork in the late 1990s. Very little has happened since then, despite the fact that the Irish Medicines Board has said the building is unsuitable for long-term use and is not compliant with good manufacturing practice. Although the Southern Health Board has offered a site for a new building, the Government has delayed the project regardless of its many promises. I call on the Minister to ensure that his Department will include this project in the 2004 capital programme. In a vital area such as blood quality, the Minister should have learnt that no stone can be left unturned to ensure the highest possible standards in the most modern of buildings. The people of Cork and Munster expect no further delays on this vital project.

Mr. Martin

The Irish Blood Transfusion Service is inspected twice yearly by the Irish Medicines Board, which is the regulatory authority for the service. The Irish Medicines Board identified a number of deficiencies following an inspection of the service's Cork centre between 3 and 5 December 2003. A presentation on the board's findings was made by the IMB's acting chief executive officer at the IBTS board meeting of 10 December 2003. The presentation was viewed with the utmost seriousness by the board. The matters raised by the IMB were addressed and appropriate action initiated. The position in this regard is being monitored closely by the board.

As the Deputy said, one of the deficiencies highlighted by the IMB related to the operation of the irradiator at the Cork centre. An irradiator is a machine which exposes blood products to a source of ionising radiation as a safeguard against possible post-transfusion problems. During inspection, it was noted that the irradiator required recalibration. This process has been completed and a risk assessment report on the irradiator machine in the Cork centre is due to be finalised shortly. Another deficiency identified by the IMB related to the pressure on existing quality assurance resources at the centre. The centre has vacancies for a senior technical officer and a quality assurance officer, but it has experienced difficulties in attracting applicants of a suitable calibre for senior posts. The technical post is being filled on an acting basis while the quality assurance post has been vacant for a number of months. Further efforts are being made to fill the posts in question, including the use of a recruitment agency and the extension of the advertising campaign to include the UK.

As the Deputy noted, the IMB expressed concern about the potential for inadvertent reissuing of recalled product. The IMB inspectors noted that problems might arise between the procedures for blood returned for re-routing between hospitals and procedures for dealing with blood returned for other reasons. They sought greater clarity with regard to the different procedures.

The re-routing programme allowed for the transfer of unused units of blood from one hospital to another, to make the best use of resources. Re-routing occurred if units of blood were issued for a specific patient to a specific hospital, but not used for that patient and were not immediately required by that hospital for another patient. The units were returned by the hospital to the Cork centre in such cases. The centre verified that the units had been suitably stored while they were in the hospital. When this verification had taken place, the units of blood were re-routed to Cork University Hospital, which has a higher usage of blood than other hospitals in the city. The re-routing programme has been discontinued pending a full review, as a response to the concerns expressed by the IMB. The standard operating procedures governing the re-routing programme and the product recall system are being reviewed with the assistance of external good manufacturing practice consultants.

Another deficiency highlighted by the IMB inspectors, as the Deputy has correctly identified, related to the building at St. Finbarr's Hospital which is used by the Cork centre. The inspectors indicated that the building was unsuitable for long-term use and was not compliant with good manufacturing practice standards. The IBTS and the Department are aware of the difficulties with the building and are working together to develop a suitable alternative. The development brief for the new Cork centre project was submitted to the Department by the Irish Blood Transfusion Service in March 2003. The capital cost of the project, inclusive of special testing facilities, is estimated at €28 million. Departmental officials are in discussions with the Department of Finance to agree a capital programme for 2004 and subsequent years. The Cork centre is one of my major priorities for approval as part of this programme. The issue of identifying a proper site delayed matters for some time.

While planning for the new centre is in progress, the board of the IBTS approved an interim development for the Cork centre in November 2003 to comply with IMB quality assurance standard recommendations. This interim solution for the ongoing delivery of services will be required for the next three to five years. The development, on the St. Finbarr's Hospital site, will cost an estimated €2 million, to be met from the IBTS's resources. The Southern Health Board has given its approval for the development of the interim facilities on the St. Finbarr's Hospital campus. The IBTS hopes to be in a position to apply for planning permission in the next few weeks.

Interviews for the position of architect to head up the design team for the interim refurbishment of the Cork centre have just been concluded. Shortlisting for the remainder of the design team is complete and interviews are being arranged. It is intended that the design of the facility, the seeking of planning permission and the procurement of interim construction works will be fast-tracked to ensure the earliest possible completion date. I am being kept fully briefed about the development of the Cork centre. I discussed capital facilities at the Cork centre with the chair of the board and the acting chief executive officer at a meeting on 10 November last. At this meeting, I confirmed my commitment to the provision of a new centre in Cork at the earliest possible date. I am committed to ensuring that the IBTS continues to have enough resources to maintain the highest possible standards in blood transfusion practice at all locations throughout the service.

Hospital Inquiry.

An Ceann Comhairle

The final two matters have been taken together. Deputies Brendan Smith and Ó Caoláin, who have raised the issue of the recent difficulties in Cavan General Hospital, including the suspension of two consultants and the death of a young person, will have five minutes each.

Mr. B. Smith

I am very grateful to the Chair for giving us an opportunity to speak about this important subject. I am glad the Minister for Health and Children, Deputy Martin, is present in the House as we approach the midnight hour to hear our concerns.

At the outset, I extend my sincere sympathy to Brian and Rosemary Sheridan and their family on the death of their daughter, Frances. The North Eastern Health Board has announced that it has appointed an expert group to report on all the circumstances surrounding the death of Frances Sheridan. I appeal to the Minister to direct the health board to carry out the investigation in the most thorough manner possible and to complete it with the minimum of delay. That is the very least the Sheridan family deserves at this tragic time.

Last June I raised, by means of a parliamentary question and on the Adjournment, my concerns that surgical services were under threat at Cavan General Hospital. I expressed particular concern at that time about the threatened withdrawal by the Royal College of Surgeons of recognition of five surgical trainee posts in the hospital. The Minister for Health and Children was requested last August by the CEO of the North Eastern Health Board to establish an inquiry following the suspension of two consultant surgeons. It has been stated repeatedly that the suspensions arose from interpersonal difficulties between the two eminent surgeons. Management, particularly human resource management, is about dealing at the coalface with difficulties and grievances that arise in the workforce. Surely in this day and age there is enough know-how and expertise within an organisation the size of the health board to deal with interpersonal difficulties among some of its most senior employees. This type of issue, albeit a very important matter, should not end up with the Minister and subsequently with an inquiry. These issues should be dealt with and finalised by the employers of the concerned parties and emerging difficulties should be dealt with firmly, conclusively and fairly.

I gather from the Minister's comments in the broadcast media this evening that he has been frustrated, to say the least, in making progress on the inquiry. A third committee has now been established in the inquiry. It is obvious, judging from media reports, that the Irish Hospital Consultants Association has not acted in a manner to facilitate the speedy progress of the inquiry. It is also obvious that the conditions sought by the IHCA before it would nominate two members to sit on the inquiry have delayed the whole process. I would have thought an association such as the IHCA in its representative capacity would do everything possible to represent and protect the legitimate interests of its members, including the utmost co-operation with the inquiry so that it may undertake its work in a thorough and diligent manner and in the quickest possible timeframe. I hope the latest appointed committee can complete its work in a short period.

I meet on a constant basis with people who outline their great satisfaction with the work and expertise of the three consultant surgeons attached to Cavan General Hospital. I also know of the excellent work done and treatment provided in the medical department. The personnel attached to Cavan General Hospital in all disciplines are quite rightly held in high esteem by the community of Cavan-Monaghan, north Longford, south Leitrim and north Meath. Unfortunately, in every hospital there are some outcomes following surgical procedures or medical treatment which give rise to legitimate grievance and mourning for some families and, sadly, no way back for the patient.

The issues at Cavan General Hospital need to be resolved without delay. I understand that the medical board of the hospital recently contacted the Minister requesting a meeting. My advice to the Minister is to meet those representatives of the hospital staff. They are eminent medics whose priority is the good of the hospital and the well-being of the people of the hospital's catchment area. Cavan General Hospital is a relatively new hospital, with the most modern facilities. We want this hospital and all its departments, with its committed staff, working to full capacity.

Caoimhghín Ó Caoláin

I wish to share a minute of my time with my colleague, Deputy Crawford. I thank the Ceann Comhairle for the opportunity to speak on this important issue and I join Deputy Brendan Smith in welcoming the Minister to the House at this late hour.

The failure so far to have the promised inquiry into the dispute involving two now-suspended consultants at Cavan General Hospital is grossly unfair to the staff of the hospital, to the two suspended consultants and above all to the people of the region served by the hospital. At this stage the inquiry should be concluded and its recommendations already acted upon. I reiterate my call to the Minister to intervene directly and immediately in this unacceptable matter. It is a scandal that a dispute involving the IHCA over what doctors serving on the inquiry may be recompensed has resulted in this delay.

Back in August, when matters first came to a head, I called on the health board executive to ensure that the suspensions caused minimum disruption to patient services, as it had promised in its statement, but that has not been the case. Even prior to the suspensions, the dispute placed additional pressure upon the staff of the hospital. With the closure of the accident and emergency department at Monaghan General Hospital the position became untenable and this has continued up to the present. The Government bears much of the responsibility for the now inadequate provision of acute hospital care in the Cavan-Monaghan region. This follows on the closure of the maternity unit and the accident and emergency department in Monaghan.

The death of nine year old Frances Sheridan of Cootehill has added to concerns about the difficulties at Cavan General Hospital. I visited the family of the deceased child yesterday in Cootehill and I again express my sympathy to Brian and Rosemary Sheridan and their children in this time of terrible grief. However, pending the result of the autopsy and the report of the health board inquiry, it is too early to draw conclusions. Whether this tragedy is directly related to current difficulties at the hospital is an open question. The family expressed gratitude in my presence for the care and support they have received at Cavan General Hospital in the past, which I and countless thousands of others would also willingly declare. However, it is long past time for all these issues to be addressed, including the commencement and conclusion of the promised inquiry into what led up to the suspension of the two consultants, the stabilisation of the consultant presence at the hospital and the restoration of on-call status to Monaghan General Hospital, which is a related difficulty.

Mr. Crawford

I thank Deputy Ó Caoláin for the opportunity to speak on this tragic issue. The death of Frances Sheridan, aged nine, has brought back into the limelight the extremely serious problem of the mismanagement of Cavan-Monaghan hospital group. I express my sympathy with the Sheridan family, as I did personally yesterday. I am disgusted by the media intrusion into this family's great tragedy.

The problems of this hospital group have gone beyond a joke. Top-quality nurses and staff are under severe pressure because of the Minister's lack of leadership and that of the health board executives. The health board members must also carry the blame, because all but one of those representing County Cavan ignored the problems being experienced in Monaghan and now the overflow from Monaghan General Hospital is causing many of the problems at Cavan General Hospital. The Minister has failed to bring Monaghan General Hospital back on call since last July. The health board management and the Minister have allowed Cavan General Hospital to lurch into a similar situation, with many patients failing to receive the treatment they deserve. Good hospital staff and services are now receiving very bad publicity. The Taoiseach must take responsibility for this and the Minister must come under scrutiny and consider his position. I have had a good relationship with the Minister and have worked closely with him as much as I could. However, Monaghan General Hospital is still not on call and there are serious problems in Cavan General Hospital. There are serious questions to be asked. People and patients must come first. Internal disputes and management problems must be dealt with by someone who cares — someone who will take things under control.

I will finish with a quote from a five-page letter I received from a Cavan constituent who was treated in Monaghan General Hospital:

In the fifties, dedicated doctors and nurses were fully equipped to deal with patients on arrival. Now fifty years later, in the age of modern times and technology, we are fighting for and praying for hospital survival.

I will pass this letter on to the Minister because it is revealing.

Mr. Martin

I thank the Deputies for raising these issues on the Adjournment. I take this opportunity to offer my deepest sympathy to the Sheridan family on the death of Frances. I do not propose to comment on the specific circumstances of the case in respect of the family's privacy at this time. In addition, the State pathologist has conducted a post mortem, the results of which are awaited.

This afternoon, I met the chief executive officer of the North Eastern Health Board and was briefed on the board's response. An expert group has been established by the chief executive officer to undertake a review of all factors involved in the case. The review will cover the period from Frances' first contact with Cavan General Hospital on 7 January 2004 to her untimely death on 1 February 2004. The expert group is comprised of senior clinical, nursing and risk management personnel. The chief executive officer has assured me that the review will be completed as a matter of urgency.

With regard to the suspension of two consultant surgeons in Cavan General Hospital, I have recently appointed a committee of inquiry to examine matters of complaint against the two consultants. The two consultants concerned have been suspended without pay since August 2003. The recently established committee is the third such one to be appointed by me in this matter. The legislation details and provides the framework by which these committees are established. Once the health board has notified the Minister of suspension, he is obliged to establish a committee of inquiry. The Minister can be subsequently involved as the person to whom the person suspended can appeal the outcome of the inquiry. There is a difficulty as to what I can say about the inquiry and events surrounding it, due to this quasi-judicial role.

The first inquiry established in September 2003 had to be disbanded due to the withdrawal of both the appointed chairman and one of the consultant representatives. A second committee was appointed by me in October 2003. This had to be disbanded in December 2003 due to a perceived conflict of interest of one of the consultant representatives and the subsequent refusal of the second Irish Hospital Consultants Association nominated member to continue.

The intervening period has been taken up with an extensive exercise to identify consultants, without any potential conflict of interest, who would be willing to serve on the committee of inquiry. The Irish Hospital Consultants Association has been unable to submit a list of names to perform this work due to the non-payment of fees to its members, despite the Department's willingness to provide locum cover for both committee members, to indemnify all committee members against legal action arising from committee work and to pay travel and subsistence to the consultants concerned.

I am confident that the new committee, established with the assistance of retired consultants, will allow the matter to be progressed without further delay. My Department looks forward to receiving the recommendations of the committee in due course.

Every effort will be made to establish, as a matter of priority, the circumstances which gave rise to the tragic death of Frances Sheridan. I anticipate that the work of the expert group will be completed as a matter of urgency and will be the subject of early discussions with the chief executive officer of the board.

The Dáil adjourned at 12.05 a.m. until10.30 a.m. on Wednesday, 4 February 2004.