Adjournment Debate.

Hospital Services.

I thank the Ceann Comhairle for selecting this important matter and allowing me to address this important issue. The status of the Midland Regional Hospital, Mullingar, is a major cause of concern and angst among the public, staff and elected representatives. The HSE is a bureaucratic monster and it is engaging in a surreptitious campaign to downgrade the status of the hospital, which is centrally located to serve the citizens of counties Longford and Westmeath on foot of a commitment given in the mid-1980s. At 5 p.m., 41 acute beds or 20% of the bed complement at the hospital will close. I can anticipate the HSE's reply through the Minister of State. It will say 13 beds will be transferred to the day care unit but that is a different scenario. I am sick and tired of the HSE engaging in obfuscation in the House and putting Members off pursuing health issues.

The closure of beds will happen without formally discussing this step with consultant physicians who are concerned that the number of beds being closed is grossly excessive and disproportionate. Such a decision will cause problems for them from the perspective of safety and acceptability. I am astounded that, prior to a decision of this magnitude being made, discussions were not held with the consultant physicians, nurses and other relevant staff, and that an impact analysis was not carried out. Furthermore, a significant number of acute admissions usually occur during winter and it beggars belief that 41 acute beds will be lost to Mullingar hospital which has regional status. This is an important issue because HSE staff are intent on disregarding that designation, especially where such beds are used to accommodate acutely sick patients who attend the hospital daily. I am concerned that this is part of a discernible trend in the way the HSE treats the hospital.

Last August, I indicated that I was fearful for the long-term future of this hospital and that my confidence had been dented by a series of decisions made by the HSE in this regard. In 2008, Mullingar hospital broke even with a budget of €65 million and it has consistently been one of the top performing acute hospitals in Ireland over the past five years. The length of in-hospital stay is one of the shortest in the State. The HSE likes to refer to such achievements. Mullingar has achieved this standard frequently but it has received no payback for doing so. This efficiency has been acknowledged by the Minister for Health and Children, the HSE and others. The hospital was due €2 million because of its case mix efficiency but it only received €500,000. Why did the HSE divert money due to Mullingar Hospital elsewhere and fail to reward the hospital as promised? Where did that money go? Was a less efficient hospital given the money? It is time straight answers were given. Is it the HSE's agenda to reduce this important, centrally located and pivotal hospital to the status of a "cottage hospital"? Does the executive want to centralise everything in a flagship hospital in Tullamore with Mullingar hospital as a corollary?

Vital leadership is being given in Mullingar hospital. We are lucky to have consultant physicians of the status of Professor Seán Murphy, Dr. Aidan O'Brien, Dr. Shu Hoashi, Dr. John Cosgrave, Dr. Clare Fallen and an excellent clinical director, Dr. Ron Charles. They set up the stroke unit and they have a flagship ambulatory medical assessment unit, which processes 180 people per month. It is visited by staff of other hospitals from all over the country and our consultants are working hard to establish an intervention cardiology unit and CAT laboratory where angiograms can be performed and stents inserted without having to go to Dublin.

I have lost all faith in the HSE, as I personally have been fooled by them once too often. I do not want to hear nonsense about 13 additional day beds being available from Monday to Friday for elective procedures, as these are no use for facilitating emergency admissions. As far as I am concerned Fianna Fáil and this Government have failed the people of Longford and Westmeath in relation to hospital provision and services for the people. I was always suspicious that when Phase 2A was virtually completed in May 1997, that ways were devised, invented, formulated and found to delay the follow-on construction and establishment of an expanded Phase 2B, which was promised. It would have made eminent economic sense to follow on, but for naked political reasons this important project and the completion of same for the people of Mullingar and the wider midlands was sacrificed for political reasons.

This Government stands indicted for its failure to deliver to Mullingar what was promised, and no amount of mealy mouthed excuses from Fianna Fáil politicians, either at local or national level can disguise this irrefutable fact. It is time that people power told these Government politicians what they think. They have let us down, and there should be consequences for this blatant reneging on solemn promises given to the people over the years.

I am calling upon the HSE management and relevant authorities to enter talks with the physicians and others, to discuss a safer and fairer reduction in acute bed numbers, although my own view is that this expanding geographical area needs all its acute bed complement to accommodate its citizens.

I do not want any mealy-mouthed answers from the Health Service Executive. I want real action to secure Mullingar's long-term future.

I would be amazed if anyone could fool Deputy Penrose. I do not believe that could happen.

It only happened once.

I will be taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

The Midland Regional Hospital at Mullingar provides an extensive range of quality driven acute services to the population of Dublin and the Midlands and in particular to people in the Longford-Westmeath area. The hospital has been recognised as being one of the most efficient in the country in the context of the annual casemix adjustment. Last year the hospital was the highest in the country with a positive casemix adjustment of €1.977 million. The hospital also had one of the lowest average lengths of stay in the country at 3.3 days in 2008 and this year to the end of September the average length of stay was 3.1 days. The transfer of patients to the upgraded ward areas, which are part of phase 2B of the capital development at Mullingar, is due to take place today. The bed complement is now 158 in-patient beds, 24 day beds, six medical assessment unit beds and 11 observation unit beds, a total of 199 beds.

It is important to note that this is a reduction of 21 beds and not 41 as quoted by the Deputy.

This is chalk and cheese.

The reduction of 34 in-patient beds is balanced by a significant increase of 13 extra day beds.

The measures referred to have been taken in the interest of moving patients from the four old nightingale wards in the 1930s building to the recently completed strategy for the control of antimicrobial resistance in Ireland, SARI, compliant wards. These wards are a major improvement in terms of the standard of care that can be afforded to the patients.

The rationale behind the reconfiguration of in-patient beds to day beds is in line with encouraging a greater emphasis on the practice of day care medicine which is part of the HSE's transformation programme. The reconfiguration of the bed complement in the new hospital, including a significant increase in the number of day ward beds, aims to reduce the cancellation of the in-patient elective surgical work at the hospital. This will be done through the ringfencing of day beds in the surgical ward for surgical procedures to facilitate the treatment of gynaecology patients at the hospital on a day basis. The provision of additional day ward beds for these procedures will also help to reduce the level of cancellation of in-patient gynaecology procedures at the hospital and increase the availability of medical day ward procedures in the area of cardiac interventions and colonoscopies among others. This in turn will reduce the need for in-patient admissions to the hospital. The existing medical assessment unit, which has received much favourable comment, will also increase its throughput.

It is important to note that the revised bed complement has been fully endorsed by the consultant surgeons and consultant obstetricians at the hospital. In addition, the focus for the hospital, by agreement with all relevant consultant staff, is to increase the throughput of surgical and gynaecology work at the hospital. The provision of additional day ward beds as detailed will facilitate this increase in the workload.

It should be noted that in-patient activity at Mullingar to the end of September was 0.2% ahead of last year, while day case activity was up by 6.2% year on year. While the actual bed complement of 21 beds is a reduction in the overall capacity, the increase in the provision of day beds will ensure that Midland Regional Hospital Mullingar treats more patients in 2010 than 2009. This is in line with the proposals nationally to increase the usage of the day beds in our hospital setting. It is important to note that the current usage of day beds in Mullingar Hospital is still behind the international norms for such bed utilisation. The adjustment in beds taking place will help to improve the situation thus making the hospital even more effective in providing care and treatment in the future. I am confident that the hospital will continue to provide the best possible quality of care for all its patients.

Health Services.

This is a very serious issue. The transfer of services from HSE offices throughout the country, including Roscommon and Leitrim, will have an impact on local HSE services and staff.

The drugs payment, hardship medication, long-term illness and dental treatment schemes and the blind welfare and mobility allowances will be processed in the primary care reimbursement services offices in Dublin. We are all well aware of the confusion and disarray caused by the transfer of the over 70s GMS cards to these offices.

Decentralisation worked very well in this case. I cannot believe the Minister is undermining an excellent service and a source of employment in provincial towns. The staff of these offices are critically aware of the needs of the people in their counties. I am sick and tired of telephoning centralised Departments, being asked to press buttons 1, 2 and 3 and having to listen to songs on the telephone, which I do not have time for. Sometimes one's call is not even answered by these offices. A colleague of mine complained to me today about this very situation. The staff in centralised offices have no affinity with local areas and are far too busy.

Offices should be situated in the counties and constituencies they serve. I would like to hear the Minister's response on this matter.

I will be taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The administration of the GMS scheme and the other primary care schemes is a matter for the Health Service Executive but I will answer Deputy Feighan with as much detail as possible.

The HSE has embarked on a major programme to transform health service delivery. In the recent past various reports have clearly pointed to a lack of clarity in relation to roles, responsibilities and accountability in the delivery of the primary care schemes, including the drug payment scheme, long term illness scheme, dental treatment services scheme, blind welfare allowance, mobility allowance and others.

These reports have in particular highlighted the following: the need for standardisation, streamlining and rationalising organisation arrangements; the need to integrate all local scheme systems with an national scheme index; duplication of effort and siloing of expertise across the country; and data integrity issues leading to incorrect payments to GPs. The Committee of Public Accounts has also considered these matters in some detail.

In this context, the HSE has decided that these issues could be best addressed if all of the primary care schemes were operated centrally. Up to the start of this year, primary care schemes were processed in the 32 local health areas. However, under the HSE's 2009 service plan, the administration of these schemes will be centralised and will transfer to the executive's primary care reimbursement service, PCRS, in Dublin. Local health offices continue to provide local assistance and advice to the public as normal.

The effect of this decision is that approval, review and reimbursement of all claims for services and refunds, under all of the primary care schemes will be under central governance through the primary care reimbursement service, PCRS. The change is being implemented on a phased basis. This phased implementation will allow the HSE to continually monitor the situation and if required, modify it to address any issues arising.

The decision by the HSE to centralise the administration of these schemes has been made in the context of the requirement to realise savings in this very challenging economic environment. The change will provide an enhanced standardised service to the client population. It will deliver services for the public within sustainable levels of expenditure and with the aim of achieving efficiencies by the greater usage of shared services. The proposed changes are intended to address the concerns set out above and enhance service delivery to the client. There will be no impact on patient care or the quality of service provided and there will be no effect on the assessment of people whose income exceeds the guidelines but have a case to be considered on medical or hardship grounds, as is the norm at present. Since all applications, reviews and associated tasks will be processed centrally, this will result in a more consistent and transparent approach being applied and will not have an adverse impact on patient care or the quality of service provided.

The HSE has advised the Department of Health and Children that there are no plans to close any of the local health offices and these offices will continue to deal with queries of a general nature about the GMS and primary care schemes and will provide any assistance needed with the administration process and, along with the HSE's national helpline, will deal with inquiries from clients in respect of their entitlements and completion of forms. However, the process will involve a reassignment of existing human resources within the HSE.

This is a good example of the type of innovation signalled in the transforming public services programme announced by the Taoiseach last November. It demonstrates how improved services can be delivered within the more limited resources available in a way which meets the needs of citizens in a modern society.

I fully support the HSE's decision to centralise these administration processes to one location as the HSE has advised that when fully implemented the measure will ensure the following — improved turnaround time for the processing of applications; equitable application of eligibility across the country; consistency of service provision to customers; clearer lines of governance and accountability; and improved unified data.