Dáil Éireann debate -
Thursday, 9 Dec 2004

Vol. 595 No. 1

Adjournment Debate.

Hospital Services.

Mr. Durkan

I thank the Ceann Comhairle for the opportunity to raise this issue once again on the Adjournment. There has been a lack of clarity in regard to the continuation of TB and respiratory facilities at Peamount Hospital in Newcastle, County Dublin, for more than 12 months. The original rumour that these facilities were to be closed was denied. Subsequent to that, there was further rumour as to what might happen. Recently, all patients suffering from applicable illnesses were refused admission.

One patient suffering with a virulent infection was turned away and sent back to another hospital in Dublin from which he had been referred. This precipitated a crisis because the isolation facilities required were at Peamount Hospital and the welfare of other patients in the second hospital in terms of susceptibility to infection was in question. As a consequence, the patient had to be brought back to Peamount Hospital. It then transpired that, despite all the planning and machinations that had taken place and the grand ideas that were in place beforehand, nothing had been done in terms of planning for the treatment of TB and respiratory patients in the future.

I have found in recent times that it would be easier to get information from the Kremlin than to get replies to parliamentary questions on health issues. The response to almost every such question is that the issue in question is a matter for the relevant health board and that the Minister has referred the Deputy's question to the chief executive officer. One might be lucky to receive a reply three months later. By that time, however, any self-respecting patient about whose welfare one is inquiring could have sought help and succour elsewhere. He or she would not want to be waiting for a response to a parliamentary question.

This is not a reflection on the system in this House but on the quango system in regard to the health service, whereby accountability to the House no longer matters. In recent times, however, the powers that be were able to find extra beds in Peamount Hospital to alleviate the step-down facilities required at other hospitals in the city. Now it seems that TB and respiratory facilities will be scaled down. I eventually received a reply to a parliamentary question on this issue to the effect that a new consultant would be appointed for this service. I do not know where that consultant will be located.

Peamount Hospital is ideally suited to dealing with infectious diseases, has the required isolation facilities, has operated to a wide catchment area in the past and regularly brings in patients from the catchment area for ongoing treatment. I have noticed in recent times that patients have been discharged as if they have undergone a miraculous cure. Am I to understand there will be no need for the facilities previously in operation in the hospital? Peamount Hospital was the best place to provide those facilities. It was accessible and had the necessary facilities in place. When push came to shove, it was proven to be the most suitable location to which to refer patients in need of this type of treatment.

I am glad to see my former constituency colleague, the Minister of State, Deputy Seán Power, sitting opposite me. Will he deliver the goods to the patients in that catchment area and the likely patients who will be there in the future?

Minister of State at the Department of Health and Children (Mr. S. Power)

As the Deputy knows, we have been delivering the goods in County Kildare for a long time.

Mr. Durkan

Long may it continue. The Minister of State should deliver a nice package in regard to this issue before Christmas.

Mr. S. Power

Some day we will conduct a comparative study of the two constituencies of Kildare North and Kildare South. We will be quite busy in the former constituency in a few months' time.

Mr. Durkan

The Minister of State should not get into that issue.

Mr. S. Power

I am glad the Deputy has raised the situation of a hospital with which we are both familiar. Services at Peamount Hospital are provided under an arrangement with the Eastern Regional Health Authority. The background to the future organisation and delivery of respiratory and tuberculosis services can be found in a report of a review carried out by Comhairle na nOspidéal, published in July 2000, on respiratory medicine. While recognising the valuable role which Peamount Hospital had played for many years in the delivery of respiratory services, Comhairle did not regard it as an appropriate location for the future treatment of TB patients, especially those requiring ventilation and specialised treatment for other symptoms, such as heart disease or HIV.

In addition to the advice from Comhairle on this issue, the board of Peamount Hospital has developed a strategic plan for the development of services. It employed external support to assist 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 the development of new services in the areas of rehabilitation and continuing care for older people, persons with intellectual disabilities and adults with neurological or pulmonary illness.

The authority and Peamount have established an implementation group to develop a transitional plan for the hospital and to address the wider issues of the management of TB services within the region. The group consists of a respiratory physician, a specialist nurse and director of nursing from Peamount, a management representative from Peamount, a public health specialist and an acute hospital accident and emergency representative. The group has clear terms of reference that will address the key issues in relation to future service delivery. This group is due to finalise its recommendations later this month.

Services in the hospital, such as phlebotomy and X-ray, will continue to be available to the local community and indeed 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 have arisen in relation to the management of older people with chest infections and respiratory difficulties. The implementation group will also examine how these services will be maintained.

As the services in Peamount Hospital are of particular concern to the local GP community, the authority intends actively to involve them in defining the parameters of a new service to ensure that it can effectively meet the needs of the locality. Existing day and residential services for older people, people with intellectual and physical disabilities, continue to be provided at the hospital.

Following the withdrawal of services by a senior clinician, Peamount and Tallaght hospitals jointly applied to Comhairle na nOspidéal to restructure the post of a consultant respiratory physician based at Tallaght hospital. It was proposed that this physician would provide two sessions at Peamount Hospital, to ensure continuity of care. Following a meeting with the relevant hospitals and the ERHA, and after consideration at its meeting on 17 November 2004, Comhairle na nOspidéal agreed in principle, subject to formal confirmation by the parties, to restructure two permanent posts of consultant respiratory physician, one based at Tallaght hospital and one based at St. James's Hospital, to provide two sessions each at Peamount Hospital for an interim period of up to one year.

Mr. Durkan

I knew it.

Mr. S. Power

The purpose of the restructuring is to manage the transition of TB services from Peamount to St. James's Hospital and to develop a pulmonary rehabilitation service at Peamount Hospital.

The ERHA has also indicated that it will fund a temporary consultant position in Tallaght hospital for a period of three months, to allow full cover in Peamount to continue. In the meantime, it is understood that a senior medical officer in Peamount, is continuing to provide full services to patients.

The position will be reviewed following the completion of the report of the ERHA working group.

Mr. Durkan

I knew it. The TB section is to be closed. Another nail in the coffin of the health services.

Food Safety Standards.

Mr. O’Dowd

This is the second debate I have had on this issue with the Minister of State, Deputy Brendan Smith. A recent case which was heard in the High Court for nine weeks has been settled between the Department of Agriculture and Food and Irish Edible Oils. Millions of euro were spent on this court case and it caused serious concern among the public, particularly readers of the Drogheda Independent.

In the course of the court case it was claimed that the pipe used for the discharge of risk material was also used, at other times, for washing out oils which were not specified risk materials. What risk, if any, does this present to the people who use the product made by Irish Edible Oils?

I have met the Food Safety Authority. Like me, the authority is strongly of the view that the Minister for Agriculture and Food must immediately commission an independent report to establish the impact, if any, of the occurrence alleged in court. I stress that the allegation has not been proved and I accept that. Nevertheless, risk assessment needs to be done to see how the health of the population might be affected by what is alleged to have happened.

That is the core of the issue. Will the Minister carry out that assessment immediately? I understand it would cost in the region of €40,000, which is nothing compared with the cost of the recent court case, which amounted to millions of euro. Such an assessment could be concluded quickly, effectively and efficiently by a company which has already done much of the work.

Minister of State at the Department of Agriculture and Food (Mr. B. Smith)

My Department and two other defendants were sued in the High Court by a company in Drogheda, which had been contracted by one of the defendants, but not my Department, to store tallow derived from specified risk material, SRM. I do not propose to comment on the specifics of the case, other than to say that my Department and the other defendants have reached a settlement with the plaintiff without admission of liability.

From February 1997, Ireland, as part of its national BSE control measures, introduced arrangements for the removal and destruction of SRM. Part of this system was the designation of a specific rendering plant to process this material. The resultant SRM meat and bonemeal and tallow was to be sent out of the country for incineration. Prior to sending the tallow abroad it became necessary to store it. Storage was arranged by a representative of the rendering plant at the premises of the plaintiff company under the supervision of my Department's veterinary inspectorate.

The specific allegation referred to by the Deputy is based on a statement made in the course of the case by a former employee of the company. However, a report prepared by the former managing director of the plaintiff company on the possible cross-contamination of edible product by the tallow derived from SRM was submitted to the Food Safety Authority of Ireland on 28 April 2003. This report states: "separate hoses were used from May 1997, to pump product delivered by monery into the crude oil tanks." It further states: "only SRM product was pumped through the line dedicated to monery and there is no possibility of cross contamination between the two products through the product lines".

The reference to two product lines in the report furnished by the plaintiff company is to edible and non-edible product lines. These statements from the plaintiff company clearly rule out the possibility of such contamination as alleged to the court.

Nevertheless, my Department has had an assessment of potential BSE risk from this SRM tallow carried out by an internationally recognised risk assessment expert. That report represents an independent assessment of the level of BSE infectivity that might be present in this tallow, taking account of the material from which it was produced and the rendering process used.

It has never been demonstrated that tallow is a cause of BSE and the conclusions of this risk assessment are, as a worst case scenario, that a bovine would have to consume a tonne of this tallow to receive an infective dosage. For a human, the risk potential would be significantly reduced, due to the cattle to human species barrier that would reduce the effective exposure by a factor of 1,000 or more. On the basis of these figures the alleged contamination of tallow used in the human food chain is likely to present no more than a minuscule risk to the public.

I wish, however, to make some general comments on tallow and health risks which might or might not be associated with it. Tallow is a by-product of the meat slaughter industry. The rendering of animal by-products, including tallow, takes place in nine rendering plants in the State. These are all approved and supervised by my Department under EU legislation.

The standards applied are set in line with best EU practice, which itself is based on latest scientific knowledge. The overarching European Union BSE controls, including the rendering process criteria and the approved disposal methods for animal by-products, are regularly reviewed by the EU scientific steering committee. This committee, which is the main advisory body to the European Commission on BSE, regularly reports to the Union institutions on developments in this area. The EU Food and Veterinary Office also audits on an ongoing basis the implementation of EU legislation by member states.

The rendering process prescribed in EU legislation is essentially a series of moisture and fat reduction steps, which transform the by-products into meat and bonemeal, and tallow. Meat and bonemeal is a solid dry substance, whereas tallow is an oil. The storage, handling, transport and export for destruction of these products are also regulated by my Department in line with EU legislation.

The role of meat and bonemeal in the development of BSE in animals is well established. It is now accepted that the vast majority of BSE cases have been caused by the consumption by cattle of contaminated animal feed. Any health risks associated with animal by-products, including tallow, are the subject of regular consultation between my Department and the Food Safety Authority of Ireland. I stress that these products do not go into the human or animal food chains and are disposed of by incineration or co-incineration abroad.

As has been stated before in a debate on this issue, numerous inaccurate statements have been made about BSE in recent times. Clearly, the best approach to dealing with a subject such as BSE is to concentrate on what is known to be sound and agreed scientific fact. The points I have outlined are in this vein and I hope that on the basis of the facts outlined, including those related to a formal risk assessment, I have put the Deputy's mind at ease.

The Dáil adjourned at 6.20 p.m. until 2.30 p.m. on Tuesday, 14 December 2004.