Dáil Éireann debate -
Tuesday, 23 Mar 2004

Vol. 582 No. 3

Adjournment Debate.

Hospital Services.

Mr. McGuinness

On 27 January I tabled a parliamentary question on this issue. I asked the Minister for Health and Children to provide a 24 hour on-call CT scan service at St. Luke's Hospital, Kilkenny. I asked about the procedure in place for scans required outside the hours of service, the locations used and the costs involved. In response I was told I would receive a reply from the South Eastern Health Board in regard to the matter. As is usual, to this day I have not received a reply to that parliamentary question.

Little did I know that on the same day an 18 year old boy would require that service out of hours at St. Luke's Hospital, Kilkenny. At almost 11 p.m. at night he was asked to travel to Beaumont Hospital where he received a scan. He travelled in the back seat of his parents' car wrapped in a sleeping bag on the way back to Kilkenny where he arrived at 6 a.m. in the morning. That is an unacceptable service. The people of the city paid almost £300,000 for the provision of a CT scan unit at St. Luke's Hospital. The full cost of the unit was £600,000. At that time, there was an expectation that an on-call service would be provided seven days a week for those who required it. They did not expect that at least one patient per week would have to travel to Beaumont Hospital for scanning. Such patients have to be accompanied by professional nursing staff and this also necessitates an ambulance being taken off call. It is a waste of money and is the cause of further anxiety and trauma to the patient involved.

The 18 year old boy to whom I referred died a number of days afterwards. Many families are affected by the fact that the CT scan is not working seven days a week on a 24-hour basis. It only operates from Monday to Friday from 9 a.m. to 5 p.m. The Minister must intervene in this matter. There has been no response from the health board to requests made by hospital consultants and me on the matter.

On 24 February 2004 I asked the Minister to comment on a plan for a private operator to provide an MRI scanner at St. Luke's Hospital which would allow 750 public patients to be dealt with free each year. I tried to discover the outcome of a meeting that took place in 2003 between departmental officials and the consultant involved at St. Luke's Hospital. I asked if a needs assessment report which was prepared by the hospital was examined. I also asked if discussions had taken place with the private contractor. To this day I have not received the comprehensive response I requested.

There is a great need for this service in Kilkenny city and county and the surrounding counties. It is unacceptable that one person per week has to leave the county to access this service. What happened to the 18 year old boy is also unacceptable. I received a letter from his relatives which stated that he had spent his last night in a Dublin hospital. He travelled home tired and in pain. He never got to stay in his own home with his family again. The family found the staff at St. Luke's Hospital to be excellent, especially the nursing staff who must also be frustrated with the poor service on offer to the public in 2004. They felt that the people of Kilkenny would be outraged if they realised the limited operation of this vital service which was paid for by the people of Kilkenny. Having made a local contribution and received a commitment from the South Eastern Health Board that an on-call, seven days a week service would be provided, the health board should be asked to deliver.

We are in an age of public private partnerships and design, build and operate programmes. These terms are used by various Departments. I cannot understand why, when somebody from the private sector comes forward with a new concept of operating an MRI service and who is willing to conduct 800 free scans per year, this would be ignored, or that the response received would be so sluggish that the operator would be likely to go away. The people of Kilkenny and the region deserve better. As a public representative I deserve a better response from the health board. That family I spoke of deserves a better service. I expect a clear reply to both of my parliamentary questions and to the request made in regard to the private operator. The people of Kilkenny, who invested in that CT scan, also deserve a clear response. Any further investigation of the matter by the health board is not acceptable. What is required now is action.

Minister of State at the Department of Health and Children (Mr. T. O’Malley)

I welcome the opportunity to make a statement on the position in regard to the matters raised by the Deputy.

A CT scanning department was commissioned in St. Luke's Hospital, Kilkenny, and it became fully operational in March 2001. The scanner, which cost in the region of €760,000, was jointly funded by the Friends of St. Luke's General Hospital, Carlow/Kilkenny, and the South Eastern Health Board.

Capital funding of some €825,000 to house the new CT scanning equipment was provided by the Department of Health and Children. The CT department consists of a sedation room, CT room, CT control room, ultrasound room, conference-viewing room and ancillary accommodation. The associated revenue costs, such as the employment of a third consultant radiologist and related support staff were also provided by the Department.

The CT scanner has state-of-the-art multislice technology with rapid imaging and processing. The scanner has added capability including three-dimensional imaging and measurement of bone density in cases of suspected osteoporosis. The hospital is now in a position to image suspected pulmonary emboli on CT, which was not possible with older scanners. The installation of the CT scanner has meant that staging CTs for cancer patients can now be performed at St. Luke's Hospital.

To date, approximately 15,000 examinations on patients of all ages have been performed in the unit. The hospital has an image link to the neurosurgery department at Beaumont Hospital in Dublin, which allows it to transmit images when a specialised neurosurgical opinion is required. Arrangements can then be made to transfer the patient to Beaumont if appropriate.

The availability of CT scanning at St. Luke's Hospital has meant a great improvement in the diagnostic services it can provide for patients. This CT scanner has also been used to target biopsies and drainage procedures, which may otherwise have required open surgical procedures. The radiology department also offers high-quality ultrasound services with a second ultrasound room in the new extension. The new extension also has a sedation-recovery room for procedures.

The CT service is available to the public between the hours of nine and five, for five days a week. The Department of Health and Children has been informed by the South Eastern Health Board that negotiations are taking place between hospital management and staff representatives with regard to the provision of an out-of-hours CT service. The Department has been informed that a meeting took place with hospital management as recently as this morning on this issue.

As the provision of services at St. Luke's Hospital is a matter for the South Eastern Health Board, it will therefore be a matter for the board to decide on the extent of the out-of-hours cover required. Any extension of the existing service and resultant resource implications will need to be addressed by the health board in the first instance. Similarly the issue of access to MRI services is a matter for consideration by the board in the context of regional requirements. In this regard, an MRI centre was opened in Waterford regional hospital in February 2003 to enhance further the diagnostic facilities available in the region.

The South Eastern Health Board has submitted a needs assessment report to the Department involving the provision of MRI scanning services at St. Luke's Hospital, Kilkenny, by a private company. This issue is under consideration by my Department in consultation with the board. Significant investment has occurred in the South Eastern Health Board region and St. Luke's Hospital, Kilkenny, in recent years. The Minister and I are committed to ensuring that the hospital services needs of the region will continue to receive full attention in the future.

Mr. Neville

I welcome the opportunity to raise the issue of the difficulties at Peamount Hospital due to the proposal to close the TB facility there. Last Friday, the board of Peamount Hospital legally changed the articles of association to remove the post of medical director. It is accepted that the post is a vital one and a properly constituted hospital cannot exist without one. The Minister must intervene to stop the chief executive officer of Peamount Hospital from removing the medical director.

The number of recorded cases of TB in Ireland each year remains constant at about 400. Most patients are diagnosed and receive treatment within their own region. However, a significant minority require in-patient treatment for at least eight weeks in the specialist unit at Peamount Hospital, the only one in the State. due to personal and social factors, these patients cannot receive complex multiple therapy and follow-up tests without hospital admission. Without such facilities, these people are at a high risk of developing multi-drug resistant TB with the added danger of passing on this highly contagious form of the disease to others.

We are removing this facility at a time when enlargement of the EU is about to occur. The risk to the public health from TB is set to increase. Latvia, Lithuania and Estonia have TB incidence rates up to eight times that of Ireland. They also have a higher percentage of cases of multi-drug resistant TB which requires a longer treatment time and more expensive drugs. The decision to phase out the TB unit at Peamount will remove an essential safety net in the fight against TB. It is the only place with a good record of treating those patients who cannot manage self-treatment. The removal of the Peamount facility will create a danger of higher rates of multi-drug resistant TB in Ireland and experts claim that this is a real possibility. Last Friday, the first reported outbreak of multi-drug resistant TB took place in the Netherlands. It was claimed that a TB patient from eastern Europe had infected six Dutch nationals and it was recommended that TB control in Holland be strengthened at a time when we are removing that control.

According to the World Health Organisation, the prevalence of multi-drug resistant TB is exceptionally high in the former republics of the Soviet Union, including Estonia, Latvia and Lithuania. Drug resistance in new patients is as high as 12% in Estonia. The WHO also called for increased investment in TB prevention programmes, yet we are doing the opposite. Incidences of TB worldwide have fallen dramatically over the past 20 years. However, places that saw themselves as TB-free and removed treatment facilities experienced an increase in TB. Every country which believed it had cured TB had removed the facilities, with a few exceptions. New York state must spend $19 billion revive its TB treatment service.

The board of Peamount Hospital has decided to close the service without a request from the Minister, the Eastern Regional Health Board or the three Dublin health boards. A total of 7,794 patients attended Peamount hospital last year. There were 5,033 X-rays, 150 procedures in theatre, 806 patients admitted for an average stay of 16 days, 85 diagnosed with cancer, 72 of which were chest cancer, 48 dead and 63 cases of TB. Where are the facilities beyond Peamount Hospital to treat these patients?

Mr. T. O’Malley

The background to the future organisation and delivery of respiratory and tuberculosis services can be found in a report of a review on respiratory medicine carried out by Comhairle na nOspidéal and published in July 2000. This found that, in line with major advances in medical treatment, the optimal in-patient care of patients with respiratory diseases, including tuberculosis, is more appropriate to local acute general hospitals staffed by consultant respiratory physicians and other consultants supported by an array of investigative facilities.

While recognising the valuable role which Peamount Hospital has played for many years in the delivery of respiratory services, it was not regarded by Comhairle na nOspidéal as an appropriate location for the treatment of TB patients, especially those requiring ventilation and specialised treatment for other symptoms, for example, heart disease and HIV.

Comhairle na nOspidéal subsequently appointed a committee to advance the implementation of the 2000 report. The committee, in its report, endorsed the recommendations in the 2000 report, and this 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 who have been treated in the nearby St. James's Hospital and other major acute hospitals and who require on-going rehabilitative care could be transferred to Peamount Hospital for completion of their care.

The Minister understands that, in addition to the Comhairle advice on this issue, the board of Peamount Hospital has developed a strategic plan for the development of the hospital over the next five years. The board employed external support to assist it in this process and advise of developments in the wider health care environment. The strategy adopted by the board proposes considerable enhancement of existing services and development of new ones in the areas of rehabilitation and continuing care of older people, persons with intellectual disabilities and adults with neurological or pulmonary illness. Central to the new strategy is Peamount's duty of care to patients and the hospital's commitment to providing the highest quality care to existing and future patients.

The Comhairle report and the newly developed strategy clearly have implications for Peamount's chest hospital which comprises TB and non-TB acute respiratory medicine. In light of Comhairle's recommendations, Peamount will now develop a transitional plan to transfer the acute services in a planned way and following consultation to an appropriate location in an acute general hospital. The precise nature and timing of the changes have yet to be agreed and will involve consultation with the relevant stakeholders. The Eastern Regional Health Authority, which has responsibility for the delivery of acute hospital services in the eastern region, which includes Peamount Hospital, will participate fully in this collaborative process to ensure the interests of, and potential benefits to, patients of the region are fully realised.

Services in the hospital such as phlebotomy and X-ray will continue to be available to the local community and much of the discussion to date has related to how Peamount can more effectively meet the primary care needs of the local population. After discussion with local GPs, it is clear that key concerns are in regard to the management of older people with chest infections and respiratory difficulties. The authority is in continuing discussion with Peamount in regard to how these services will be maintained. This approach will be supported by the appointment of a consultant geriatrician to Tallaght-Peamount hospitals, approved by Comhairle, with two sessions per week specifically committed to Peamount. A joint consultant post in rehabilitation medicine is also being established between the National Rehabilitation Hospital and Peamount. The authority is also working with Peamount to ensure continued rehabilitation facilities would be available for those people with TB who have chronic lifestyles and are at risk of being unable to maintain their treatment programme without supervision. Existing day and residential services for older people and people with intellectual and physical disabilities continue to be provided.

In conclusion, I would like to assure the Deputy that the direction which Peamount is now taking will see it developing its overall role and its support for acute hospitals, general practitioners and the community of the surrounding area. It is in line with its duty of care to patients and its commitment to the provision of the highest quality of care to existing and future patients.

Social Welfare Benefits.

An Leas-Cheann Comhairle

The remaining two items will be taken together. Each Deputy has five minutes and the Minister has up to ten minutes to reply.

Mr. Wall

I wish to share time with Deputy Penrose.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Mr. Wall

I am pleased the Minister came back to the House in regard to this matter. Given the wording of the Adjournment debate matter, it is a sensitive issue.

A widow who has suffered the loss of her husband in tragic circumstances set out to care for her two daughters. In starting a new life with a new partner, this woman has become pregnant and must go on maternity leave. In reply to a question today, the Minister stated she will review this issue on an ongoing basis. Under the old social welfare system, there was a limited number of exceptions to the general principle in this regard. These widows, who have paid social welfare contributions, are in a unique position. There is a need to support these widows who are pregnant. Obviously one person will not receive two payments, as a baby is involved.

This issue is an exception to the rule. The Minister stated in her reply today that she introduced measures on Government spending to provide scope for other improvements in the social welfare system. She said it is her intention to keep this matter under review. A case can be made in this instance. Even though these women receive help and care from their partners, they encounter problems in beginning a new life for themselves. There is the trauma of losing employment for that length of time during which there will be an obvious loss of wages. The loss of social welfare benefit puts tremendous pressure on these people in trying to care for children and dealing with pregnancy.

This is a special case and the Minister could deal with the anomaly by keeping the matter under review. This is a sensitive issue in which a small number of people are involved. I have met these people and seen the pressure and torment they are suffering. They have been in full-time employment and caring for their children. As these people have been excellent parents, something must be done for them. I ask the Minister to consider this matter to see what can be done. Given her goodwill in the matter, the fact that she will reassess the situation and the overall debate on the plight of widows, this is one issue the Minister should look at to see what can be done.

Ms Harkin

I sat in the House earlier listening to the usual rant about the amounts of money being spent by the Government as if in some way it was its own money it was spending. I have said on many occasions in this House that what it is spending is taxpayers' money. The question is how it spends the money. Are we spending that money wisely and well? Is our social welfare system delivering an equitable system? Is it looking after the most vulnerable? Can people believe that our social welfare system provides a cushion and a support for those who need it most? After listening to what went on in this House this evening, the answer to the three questions is "No".

I was most disappointed to hear the Minister say during Private Members' business that there was a decision to cut the half benefit payable, for example, disability benefit, to widowers, widows and those on deserted wives benefit, when these people are in receipt of a contributory widow's pension. No matter how hard she tries, the Minister cannot now, nor in the future, convince us that to further penalise these people who are in a vulnerable position can ever be just, fair or equitable. She must be aware of a court case taken by the former President, Mary Robinson, in the early 1990s, when she argued the case for full disability benefit or unemployment benefit while in receipt of a widow's pension. She must be aware that the High Court and the Supreme Court held against the Government. The judges used the words "illegal" and "unfair". What was true in the early 1990s and upheld by the highest court in the land, is still true today.

I listened while the Minister outlined the improvements in social welfare benefits for widows and widowers. I will probably be one of the few people on the Opposition side who will agree that there have been improvements. It was interesting that she used 1987 as a benchmark year. The cost of living and rates of pay at the time bear no resemblance to what people earn now, therefore, neither should social welfare payments.

The Minister referred to those who will receive company sick pay. As a widow, I was fortunate enough to find myself in that position but we are talking about those who do not have such support. I listened with a sinking heart when the Minister said there were a limited number of exceptions whereby a recipient of widow's or widower's pension or one parent family payment could receive short-term social welfare benefits, such as disability benefit, at the same time. We all know why these exceptions exist; they are exceptional circumstances. How can the Minister and the Government turn their backs on vulnerable people in such circumstances?

I found the Minister's argument unbelievable. She stated that a key argument against concurrent payments is that people should not be compensated more than once for the same inability to work. Does the Minister not recognise that we are not talking about the same inability to work but the inability of two people to work, namely, the deceased partner and the surviving partner? It is not the same inability to work. How can the Minister close her eyes and her heart to these exceptional circumstances and ignore the fact that we are dealing with an exceptional situation?

How can anyone pay a mortgage or send a child to third level when his or her plans were made on the basis of two people working? Unexpectedly and often tragically, he or she is in a position where, on the one hand due to the death of a partner, and on the other hand due to illness, redundancy or another unfortunate circumstance, the family goes from being a two income one to surviving on a single payment of widow's or widower's allowance.

The Minister cannot rationalise this decision and I ask her to rescind this unnecessary and mean-spirited attack on widows and widowers. I ask her to put up her hands, admit the Government got it wrong in these circumstances and put it right.

Mr. Penrose

I note the point the Minister makes about a contingency based system, but the situation outlined by Deputy Wall related to maternity benefit payment to a widow which would only occur in a limited number of situations. Deputy Harkin is right. I was amazed and the Minister is fortunate I did not have to come after her on the point that social welfare payments are paid mainly in the case of an inability to generate an income, either through lack of work due to unemployment, illness etc., or through role perception, such as old age, retirement or widowhood. She stated that a key argument against concurrent payments is that people should not be compensated more than once. In maternity benefit, a person makes the contribution and expects to get the 14 weeks payment. There is a child involved and the level of outgoings, as the Minister knows well, is much greater. The Minister amended the four weeks and I was delighted that she did, but this is a limited case that will not open the floodgates, as Deputy Wall clearly pointed out.

I have only come across one such situation but the Minister's argument about concurrent payments does not stand up to scrutiny in this situation. People have made their contributions with the legitimate expectation that they would receive the money due to them. They are not being doubly compensated because the widow's contribution has already been made and they are being paid on foot of that. They have paid a contribution for maternity benefit and are entitled to get that from their source of employment. I urge the Minister to reconsider the matter and grant the benefits for the limited number of cases involved.

Minister for Social and Family Affairs (Mary Coughlan)

I outlined some of the issues specifically in my speech on Private Members' time and addressed some of the concerns expressed. I will, however, deal with Deputy Wall's problem and the circumstances he outlined.

The maximum personal rate of widow's contributory pension is €143.30 per week with an increase of €21.60 for each qualifying child. Maternity benefit, an earnings related payment, is subject to a minimum weekly payment of €151.60 and a maximum of €232.40. Depending on the circumstances, for example, the level of earnings from the employment and the number of qualified children, it may be more beneficial for a person in receipt of the widow's pension to claim maternity benefit instead of the widow's contributory pension for the duration of the maternity leave period, which can be facilitated.

In considering the impact of this measure, it should be noted that many employees are covered by companies' sick and maternity pay schemes. Under these schemes, employees are entitled to full pay or a proportion of full pay while absent from work while on sick and maternity leave. In the circumstances outlined by Deputy Wall, the employer should discuss the circumstances with the applicant and his or her decision might facilitate the issue because the person would be better off on maternity benefit than on the pension. I have noted the circumstances outlined by the Deputy and will inquire about the issue.

If anyone is entitled to say anything about widows in this House, it is Deputy Harkin because she appreciates the trauma attached to finding herself in that situation with her family. None of us has not been touched by this issue and there have been many changes in area. It will come as a surprise that there was no non-contributory widower's pension before 1997, a fact that is difficult to believe.

I met the National Widows Association and said I will discuss the issue. I agree that the baseline payment for those under 66 years of age is low and that there is a concern that, when children get older, people will lose income as a result. There are also issues arising from the changes in the household benefit schemes, such as free electricity. Those are real and pertinent issues and all of them must be addressed within the context of the available funding. As I indicated to the National Widows Association, I will review and assess the implications of these decisions.

I have listened to what people have said in the House — sometimes we lose the head but that does not matter — and I have listened to the National Widows Association. Regarding individualisation, which is a dangerous topic when discussing family, Deputy Harkin is right in her argument. Although I cannot give solace now, I will re-evaluate the situation. I have taken into consideration the views of Members on all sides and I appreciate the emotion attached not only to being widowed but to this issue as well. I assure all Members that I will evaluate this on the basis of the debate this evening.

The Dáil adjourned at 9.10 p.m. until 10.30 a.m. on Wednesday, 24 March 2004.