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Dáil Éireann debate -
Wednesday, 7 Oct 2009

Vol. 691 No. 1

Adjournment Debate.

Hospital Staff.

I thank the Leas-Cheann Comhairle for giving me the opportunity to raise the important issue of St. John's Hospital in Sligo. The hospital looks after young disabled people and the elderly. The hospital has 195 high-dependency beds. I raise the issue because of concerns expressed by hospital staff, especially nursing staff, whom I met last week. They outlined to me some of the difficulties being experienced in the hospital. They told me that currently seven full-time nurses have not been replaced and five nurses are on maternity leave, which is a deficit of 12 nurses. A total of 12 care assistants have been let go. Two senior nursing posts have been vacant since last November, while a further 20 nurses who have been working at the hospital, some of them for 20 years, are currently on one-month contracts. Staff are concerned that such staff will leave if they get an opportunity for a full-time nursing job and it is difficult to blame them in the circumstances.

It is my understanding that under the PCCC, primary community and continuing care, programme, those services were not to be affected by the moratorium on employment. Will the Minister of State please confirm whether that is the case? If it is, it is not being applied in the case of St. John's Hospital.

Unlike many services the hospital has been operating within budget. There was a proposal for a new extension to the rehabilitation part of the hospital under the national development plan. What is the up-to-date position in that regard? I raise these issues because they are extremely important in the context of the services provided at the hospital. Patients range in age from 25 to 104, the age of the oldest patient in the hospital last year. It is important, even in the context of cutbacks, that such facilities where care is given to the most vulnerable people in society are protected.

I am replying to this Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank Deputy Scanlon for raising this issue on behalf of his constituents. It provides me with an opportunity to outline the background to the current situation and to update the House on the action taken by the Health Service Executive.

As Deputy Scanlon is aware, Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. Where that is not feasible, the health service supports access to quality long-term residential care. The Health Service Executive has operational responsibility for the delivery of health and social services, including facilities such as St. John's Hospital in Sligo. It is a community hospital which has provided continuing care services to older people since 1972. It comprises four continuing care wards, one rehabilitation ward, a day hospital, a physiotherapy department and an occupational therapy department. The facility has a total of 195 beds, which includes continuing care residential beds, dementia, respite and convalescence beds. As of 30 September 2009, all 195 beds were occupied.

A full-time medical officer is employed to provide medical services to all inpatients except those in the rehabilitation department, which is under the care of a consultant geriatrician. As part of a recent HSE review of "Medical services in the Acute Hospital, Sligo General Hospital and St. John's Hospital" it is proposed to implement a plan where a consultant geriatrician would provide additional sessions to the care of continuing care patients in St. John's Hospital. There has been no reduction in the provision of medical cover and the proposal will enhance that provision.

There is a funded complement of 106.5 nurses, as measured in whole-time equivalents, in St. John's Hospital. Currently, there are three staff vacancies while five staff are on maternity leave and three staff are on long-term sick leave. The director of nursing deploys staff to ensure that there is no clinical risk. There is a funded complement of 63 whole-time equivalent staff. Currently, there are three vacancies with an additional three staff absent due to sick leave. Again, the director of nursing redeploys staff to areas of greatest needs to maintain safe levels of care.

No beds are closed in St. John's Hospital. Management regularly reviews staffing levels to ensure that patient safety is not compromised. The capacity of the executive to provide approved levels of service continues to be reviewed in the context of overall resource availability. The local health manager has a clear responsibility to deliver services within allocated budgets and consistent with human resource directives. That includes any decision on prioritising resources and the impact it may have on providing cover at all facilities. That requires a stringent ongoing review of the application of the resources.

The Government is clearly committed to the development of comprehensive services across the country. As I have outlined to the House, the Department of Health and Children will continue to work with the Health Service Executive to advance that objective.

Hospital Services.

I thank the Ceann Comhairle's office for granting me the opportunity to discuss this matter during the Adjournment debate this evening. I welcome the Minister of State with responsibility for children and young people, Deputy Barry Andrews, to the House.

It is a matter of desperation that I bring this matter before the House. I have never previously raised a health issue on the Adjournment debate. It is a sign of the significance of the issue that I have done so this evening. Cian O'Brien is a four year old child. He will be five in a couple of weeks time. He was born with cerebral palsy and developed severe epilepsy when he was two. The epilepsy was controlled by medication until March of this year. Since then his epilepsy has become worse and he has been in Cork University Hospital since May. The team of doctors and nurses that has looked after him has been doing a remarkable job and his family is extraordinarily grateful. They know that without the team's work, the child would have died.

Cian has intractable epilepsy. He is under the care of Ms Olivia O'Mahony, consultant neurologist at Cork University Hospital, who has tried every medication to try to control Cian's seizures. These seizures can occur up to 400 times per day. After numerous ECGs, MRI scans and other tests in Cork and the children's hospital in Temple Street, it was decided that Cian needed life saving brain surgery. His family were advised at the start of August that the operation would take place in Beaumont Hospital within the first two weeks of September. They were told a team of 21 medical staff would be involved in the operation. The operation would involve a radical procedure being carried out which involved splitting his brain.

On 1 September, Cian's consultant neurologist was contacted by the team in Beaumont to say that it was ready to "go" but did not have a paediatric anaesthetist and that contact would be made again when one was secured. The consultant neurologist at this stage suggested that the family try to have the operation carried out in Great Ormond Street in London, but they were advised that this would take too long and that the HSE would instead carry out the operation in Beaumont. On Friday, 18 September, Cian's family were advised by their consultant that Beaumont had been in contact to say again that it could not get a paediatric anaesthetist and therefore cannot do the operation.

I have just one question for the Minister. When will this child have his operation?

I am responding on behalf of my colleague, Deputy Mary Harney, Minister for Health and Children. The HSE has informed the Minister that the case of the child in question, which is complex, has been the subject of discussion between Cork University Hospital and the relevant specialists at the Children's University Hospital, Temple Street. Owing to the serious nature of this case it is being dealt with as a priority. In the circumstances it has been agreed the patient should be treated in Beaumont Hospital and the clinicians involved are currently working to agree a suitable date for surgery.

In Ireland, adult neurosurgery is undertaken in Beaumont Hospital in Dublin and in Cork University Hospital. There are currently 13 posts of consultants in neurosurgery, of which four have a special interest in paediatrics. Currently, service provision for paediatric neurosurgery is spread between the two adult neurosurgery centres and two of the children's hospitals in Dublin. All paediatric neurosurgery services will eventually be provided at the new national paediatric hospital.

The HSE commissioned a review in 2007 of current paediatric neurosurgery services in Ireland. This clinically-led review supported an approach in which all paediatric neurosurgical activity is undertaken by trained neurosurgeons with a special interest in children, with close links to the adult neurosurgical service and in an environment which is focused on the needs of children. This has informed an early decision to approve two neurosurgery posts with a special interest in paediatrics. The HSE has allocated €2 million from development funds provided in 2009 to support the development of a citywide paediatric neurosurgery service in Dublin. The two consultant posts are being progressed through the recruitment process and two consultant anaesthetist posts have been advertised to support this service.

This also shows the urgent need to bring together all complex hospital services for children in one national paediatric hospital.

With respect, all I wish to know is when the child will have the operation.

In this regard, the House will be pleased to note the confirmation earlier today at the Oireachtas health committee by the HSE chief executive, Professor Drumm, that Our Lady's Hospital for Sick Children, Crumlin is to begin engaging fully with the development of the new paediatric hospital and will have representation on the hospital's development board.

I thank the Deputy for raising this issue. The Minister says she is very hopeful that the patient involved will receive the surgery he requires at an early date.

As of this evening there is no date for this child's surgery.

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