Vol. 729 No. 5
30 Deputy Billy Kelleher asked the Minister for Health and Children the persons that will carry out a review of the location of the new national children’s hospital; when it will be completed; and if he will make a statement on the matter. [7609/11]
The Government has committed, under the programme for Government, to the construction of the new children's hospital. Since my appointment as Minister, I have been engaged in discussions with my officials and with the national paediatric hospital board in order to brief myself on the work done on this project to date. I want to be clear about how we can best provide the hospital in the most cost effective manner while ensuring a high quality service for our children and young people.
I intend to carry out a review of the national children's hospital project and will announce the details shortly. I am currently being briefed in some detail on all aspects of the project. Following consideration of the evidence presented to me, I will decide on the scope and terms of reference of the review and the appropriate person or persons to carry out the review. I anticipate that the review, once commenced, should take approximately four weeks to complete.
It is essential that all the facts are carefully considered before a final decision is taken on the best approach. In particular, I wish to be satisfied that the hospital will provide the best possible clinical outcomes for children and young people. The Deputy may rest assured that I wish to avoid any unnecessary delay to the development of this very important project.
As this is my first time taking parliamentary questions on health I wish to congratulate the Minister on his appointment. He states that the Government has committed to the children's hospital, and he also states that it is carrying out a review. Will it take four weeks for the review to begin or four weeks for the review to be completed? Will the decision be made by the Minister alone, on foot of the recommendations made by this review body? Who will draft the terms of reference for this review? What are the terms of reference? Will they be made public prior to the review being carried out? Has the Minister brought in outside consultants, such as other organisations, agencies and interested bodies that may have expressed views publicly already?
Comhghairdeas leis an Teachta on his appointment. The review will take four weeks from the time it begins, but before we can do that, further information is required, especially in respect of the bottoming out of the money that we have available. I was given an estimate for the building cost by the last chairman of the board, but there was a €10 million variance between that and the figures that had been produced by the HSE.
I also want to be assured that we are comparing like with like, so I have asked for a costing to be done if the exact same hospital, with the exact same specifications, were built on a greenfield site. It is important that we know the difference in money and that we are comparing apples and apples and not apples and oranges. While I am acutely aware that every month this goes by costs the taxpayer €500,000, there is the possibility of hundreds of millions being lost if we build a place without foreseeing all the problems involved, and in the absence of all the facts. The draft terms of reference for the review will be drawn up by my Department. It is absolutely our intention that the review will be carried out by persons of international repute. The Government remains committed to the building of a national paediatric hospital. Obviously, we want to ensure it is built in the quickest fashion possible and in the right place at an affordable cost. I shall finish by saying the IMF is in town.
The Minister has said he needs further information prior to establishing the review group and giving it terms of reference. Equally, he has stated publicly that he has concerns about the proposed location of the hospital, as indicated. Does he still hold such concerns or will he park them while he waits for the independent review body to report? In the event that it makes a recommendation contrary to the Minister's opinion, what will happen then, or will he use this as an excuse to delay the project further?
I do not intend to delay it. My concerns remain, while my opinion is a different matter entirely. I hope my concerns will be addressed in the review, as well as those of everybody who has the best interests of children at heart. I want to know that we are building the hospital in the right place. I want to ensure any access issues will be adjudged and taken into consideration vis-à-vis the benefits of co-location from a clinical outputs viewpoint, in other words, the benefit of having an adult hospital located beside a paediatric hospital. There are a number of other concerns into which I will not go out of respect for the Chair. However, the Deputy can take it that there is no question of delaying tactics. I am very happy to say the board has elected an interim chairperson who is happy to serve, Mr. Harry Crosbie, and I welcome this.
31 Deputy Caoimhghín Ó Caoláin asked the Minister for Health and Children his plans to restore the services cut from Monaghan General Hospital. [7612/11]
Monaghan General Hospital provides day medical and surgery services, elective endoscopy, cardiac rehabilitation, non-invasive diagnostics, a minor injuries unit, radiology, diagnostic urology, dentistry, ear nose and throat and outpatient services. It also provides 13 step-down and 13 rehabilitation beds which allow patients to transfer from Cavan General Hospital and the HSE Dublin north east region for rehabilitation and step-down care. A CT scanning service which costs about €500,000 commenced in November 2010.
Monaghan General Hospital is an integral part of the Cavan-Monaghan Hospital Group. I am determined that it will continue to play an important role in the delivery of clinical services in the Cavan-Monaghan area and to patients in other parts of the north-east region.
This is the first opportunity I have had to address the Minister on issues of concern to us all. I wish him well in his new role and responsibilities. It is no coincidence that I have chosen as the subject of my first priority question to him the hospital I know best, the one chosen to act as a blueprint for the decimation by a series of former Governments of local services at local hospital sites. Monaghan General Hospital was used as a template that was subsequently visited on other communities. The Minister will recall that his party colleague former Deputy Seymour Crawford and I were consistent voices not only in support of the retention of services at Monaghan General Hospital but also post the removal of these services.
Notwithstanding what he has said in a vague and non-committal reply, will the Minister make a commitment at the commencement of this Dáil to revisit the failed hospital configuration in the north east, specifically as it affects Monaghan General Hospital, while recognising the impact of the loss of services at both Louth County Hospital, Dundalk and Our Lady's Hospital, Navan? Will he restore all acute medical and emergency services to Monaghan General Hospital, the unanimous call in March of all elected members of Monaghan County Council, including the Minister's party colleagues? Will he undertake in the first opportunity open to him to answer questions as Minister for Health and Children to give a clear commitment to the restoration of these services? Accepting that it will be programmed, will he indicate his willingness to prioritise the restoration of an emergency department and the establishment of a medical assessment unit at Monaghan General Hospital?
Monaghan General Hospital is in the Dublin north-east region in terms of hospital services. We are under severe stress in terms of capacity. Underlying the health service is the principle that the patient should be treated at the lowest level of complexity that is safe, timely, efficient and as near to home as possible. With this in mind, we are looking very closely at Monaghan General Hospital, the hospital in Navan and others in the area to see how we might best meet the needs of patients. There is no question but that the service is under severe stress. We can change the way hospitals operate and work, checking on some of the larger centres; many of the issues involved may be addressed in this manner. Equally, I am persuaded that a good deal more could be done at Monaghan General Hospital. The clinical leads and the directorate are looking at the position in the hospital and in Navan also to see how we might provide more services. We want to maximise the benefits and outputs of all hospitals but, in particular, smaller county hospitals which, to my mind, have been under-utilised to date.
Does the Minister accept that the removal of services from Monaghan General Hospital and the other hospital sites to which I have referred has created an impossible working environment for consultants, doctors, nurses and other front-line service providers in County Cavan, in particular, but also in Our Lady of Lourdes Hospital, Drogheda? That is untenable and cannot be allowed to continue.
Will the Minister acknowledge that at the time of the removal of all acute services at Monaghan General Hospital in July 2007 the previous Government made particular promises, none of which has been delivered on? I refer specifically to the promised enhancement of the primary care unit and ambulatory service for the county. The opposite has happened. Last June both the rapid response 24/7 service, with its advanced paramedic facility, and the patient transport ambulance service staffed by two emergency medical technicians were moved from Monaghan to Castleblayney to compensate for the loss of services at Louth County Hospital, Dundalk, which is now servicing all of counties Monaghan and Louth. We had no compensatory measures introduced by the last Government. I hope Deputy Reilly will be the Minister who will address the critical health care and acute hospital service needs of the people of County Monaghan.
There is absolutely no question but that there are big issues facing the health service. There is also no doubt that promises were made in the past and not kept. When certain plans for reconfiguration were designed, the part dealing with the removal of services was enacted with great haste, while that which was supposed to address the central delivery of services was much slower in coming about, or very often did not come about at all. It is not the intention of the Government to repeat that process. I would be first to admit that we must go through a process of rebuilding trust between the health service and those who use it. That is a big job and I hope Members on all sides of the House will co-operate in achieving it.
32 Deputy Stephen Donnelly asked the Minister for Health and Children his plans, including investment, targets and timelines, for the reform of palliative and end of life care, in order that persons are afforded the dignity and respect they deserve and receive appropriate, high quality care in an environment of their choosing. [7783/11]
Palliative care services are delivered by the Health Service Executive, in partnership with voluntary organisations. The overall budget provision for these care services in 2011 is €74 million.
My immediate aim is to ensure that the priorities, targets and time lines for palliative care, as detailed in the agreed HSE Service Plan 2011, are achieved as intended by the end of this year. These include the delivery of specialist palliative care services to almost 3,600 people each month in 2011; promoting care at end of life projects through the design and dignity grants scheme . The purpose of this scheme is to develop a range of exemplar or demonstration projects within a hospital, region or sector which will guide future development relating to end of life issues; progressing phase 1 of the palliative care policy for children with life limiting conditions in Ireland. Ultimately, this policy aims to ensure that all children with these conditions will have the choice and opportunity to be cared for at home. It recommends the appointment of a consultant paediatrician with a special interest in paediatric palliative care and eight outreach nurses — a successful candidate has been identified for the consultant post and will take up duty shortly; and implementing the minimum data set for palliative care. This is designed to provide better information on all patients availing of specialist palliative care services to further improve the planning and delivery of services.
I also intend that the various capital projects agreed under the HSE service plan for this year will be progressed. These include completion of the projects at Marymount Hospice, Cork and St. Ita's, Newcastlewest, in addition to minor capital works at local level. Palliative care and end of life issues will continue to be developed within the overall continuum of care services and within the context of the current budgetary and fiscal climate.
I thank the Minister of State for that response. We have some examples of good practice, for example in Limerick and in the mid-west where we have the 30 hospice beds and the multidisciplinary teams. The target is one hospice bed for every 10,000 of population. Three regions have that, two are at 40%, two are at 30% and three regions have none, not a single bed. Wicklow, the area I know best, has no beds although it is part of a different region. The home care team has four nurses, one of whom is on maternity leave and another on sick leave, but because of the recruitment freeze, those positions cannot be filled, even temporarily. Therefore, Wicklow has only two nurses for the whole area. I suggest to the Minister that the issue is one of variance and would like to know what is being done about that. For example, where we have best practice — in Limerick — the State spend is €30 per head, but in Wicklow the spend is €3 per head. What is being done to provide best practice around the country?
Deputy Kelleher will know we have been extraordinarily well served in Cork with the hospice movement there. On the question of the gaps that exist, a palliative care service medium-term development framework was published by the HSE in July 2009. This sets national priorities which have been agreed by all stakeholders, based on solid needs analysis, to ensure that services do not develop in an ad hoc fashion and that any developments proposed in future reflect areas of greatest need. This methodology ensures an equitable approach to service provision, as well as consistency of inputs, such as pay and non-pay costs and staffing levels. I take on board the Deputy’s comments. No matter where people are, their needs are the same and we must ensure an equitable delivery of the service.
I have the 2009 plan here and agree it is a good plan. I suggest the HSE is the problem and that it is a managerial problem. For example, in Wicklow there is co-funding of €3 million for a €6 million hospice and an ongoing operational expenditure is proposed of €2.5 million. We know this is provided at a cost saving and that in terms of the economics, it saves us significant money. As the Minister pointed out, we are now in a Fianna Fáil-induced IMF world and must try to save money. While I am delighted the HSE report has been made and bought into by the stakeholders, the people within the hospice world to whom I have been talking say there is no transparency within the HSE. In Wicklow, for example, there has been a local buy-in to the plan, but it disappears into the morass of the HSE. Can anything be done about that organisation, which does not appear to be reacting to its own plan, specifically in an area which could save us significant money and provide better health care to people all over the country?
The Deputy has asked some relevant questions. We cannot, for the very reasons the Deputy has asked the question, have a county by county, or regional approach to this. We must pull it together and have a national service. The national steering group on palliative care is the way to go. This is chaired by the HSE, but driving out the plan will ensure we have a more equitable approach throughout the country. I hear the Deputy's concerns.
33 Deputy Billy Kelleher asked the Minister for Health and Children the number of beds in hospitals here that are currently closed; if more bed closures are likely in 2011; and if existing closed beds will be reopened. [7610/11]
There are approximately 11,600 inpatient beds and 1,800 day beds in the public hospital system. The number of beds available at any one time fluctuates, depending on planned activity levels, maintenance and refurbishment requirements and staff leave arrangements. Beds may also be closed from time to time to control expenditure, given the need for every hospital to operate within its allotted budget. I am advised that based on the existing methodology, approximately 960 acute beds are closed at present, but this cannot be regarded as a precise figure because hospitals have been using different criteria to measure bed closures. This is an issue I wish to address and I have spoken to the Secretary General and the HSE about it. The issue will be addressed because we cannot allow a situation where we cannot compare like with like. I want to examine closely the practice of closing beds to control expenditure, because this does not make economic sense. The HSE is at present reviewing the existing methodology for measuring bed closures in acute hospitals to ensure that a consistent approach is applied across the public hospital system.
It is important in any case to emphasise that hospital beds represent a service input and are not in themselves a measure of how the system is performing. By this I mean that while hospital beds are a measure, they are not a measure of the overall activity. Many of the procedures we undertook in the past which required admission and inpatient beds can now be performed without admission, through single day surgery and so on. In recent years there has been a much increased emphasis on improved efficiency in acute hospitals. In particular, the focus has been on reducing inpatient care activity levels through the provision of more appropriate service responses, delivering a shift to care on a day case basis where appropriate and on performance improvements such as surgery on the day of admission and reducing inappropriate lengths of stay. Specific targets under these heading are included in the HSE's National Service Plan 2011. Clinical directors are looking at this closely. Much of what happened in the past in terms of admitting patients the night before surgery was unnecessary.
Additional information not given on the floor of the House
In this context the HSE's directorate of clinical strategy and programmes is leading a coordinated programme of work to improve service quality, cost-effectiveness and patient access and to ensure that care is provided in the setting most appropriate to individuals' needs, with due regard to patient safety considerations. I have met the clinicians leading this multidisciplinary process and strongly support their work, which I believe will enable services to be delivered in a manner that is appropriate and sustainable into the future.
There are approximately 13,400 beds in the public hospital system and the Minister has said that approximately 960 of these are closed at present. While this may not be an accurate measurement, we can take it that the number is between 890 and 960. Does the Minister suggest that to address the closure of hospital beds, he proposes reducing the overall number of beds and keeping the reduced number of beds open all the time? Does he intend to reduce the capacity and the number of beds in the system as opposed to having a large number and sometimes closing them when hospitals run into difficulties?
There is no intention on my part to reduce the capacity any further. I believe we have the waiting lists we have because we do not have sufficient capacity. Before there is any reopening of beds, I want to ensure we get the maximum value from the beds we have. I have met the clinical teams and in many cases we could have many more discharges within 48 hours of admission to hospital. We could organise our situations in a very different fashion. If a surgeon arrives in the morning and can only do three out of the eight cases he or she was supposed to do, that is a management issue in failing to provide the nurse, intensive care bed or theatre staff. Those situations will be addressed and we are reviewing that with management. In fairness, there has been a problem for some time and there will be considerable change. I am very pleased that the change has started already and I am very encouraged by the appetite for change of many of the people working within the system. By the end of this year I hope to be able to give the Deputy much better news than the news we are experiencing today.
Does the Minister concur with most of the opinions expressed in the 2011 national service plan with regard to the increased capacity required in the hospital service and more importantly the efficiencies, including people coming in on time, being treated and then leaving as opposed to waiting for procedures over a number of days? Is the plan sufficiently detailed and to his satisfaction?
The best way to answer that is to say we are working through the plan at the moment. As the Deputy knows, it is quite a complex plan. I hear loudly what he is saying. I only recently heard about a case of a person who was fasting for two and a half days waiting for a procedure. That is just not good enough and that sort of issue cannot be allowed arise again. That also requires a change in management attitude and more real-time information, which is a major issue throughout the health service, a matter to which I will return on one of the other questions.
34 Deputy Finian McGrath asked the Minister for Health and Children his policy plans to deal with the crisis in our accident and emergency departments. [7846/11]
The waiting times for patients attending emergency departments in many hospitals during last winter and in particular the first week of January of this year were unacceptable. I am determined that this should not happen again.
The difficulties in emergency departments cannot be resolved solely within the emergency departments themselves and must be addressed on the basis of a health-system wide approach. This must start with ensuring that patients are treated in the most appropriate way in the most appropriate location. This means that where and whenever possible patients who can be treated in the primary care setting receive that treatment in a timely manner. This will ensure that patients can be confident of receiving the necessary treatment on time and that there is less need for patients to attend at emergency departments. Specifically, we need to address waiting lists for inpatient procedures — as patients are left waiting they become emergencies and end up in emergency departments.
I am in discussions with the HSE and my Department and we will have a clear plan of action to address the problems in emergency departments both for the coming year and in the long term. I am confident that with careful planning, with the implementation of the HSE's emergency medicine programme and related clinical programmes, and the roll-out of acute medicine units we will be in a position to reassure patients that the experience in emergency departments during last winter will not be repeated.
I have already stated my intention to establish a special delivery unit to tackle the problem of waiting lists including difficulties in emergency departments. Intensive work is now being undertaken in preparing the ground for the unit's establishment. I have held a range of meetings to discuss with my officials and the HSE the most effective methodology for setting up the unit and we are progressing this work with all urgency. I am very pleased to say we are getting very good co-operation.
I thank the Minister for his response. This is the first opportunity I have had to congratulate him on his appointment as Minister for Health and Children. I wish him all the best. While I know it is early days yet, there are many health policies that I would strongly support. I will revert to him in 12 months to see how he is getting on.
Is it acceptable to have patients lying on trolleys and chairs while beds are lying idle upstairs in those hospitals? Would the Minister agree that it is a national scandal to have senior citizens and very sick people lying on trolleys in corridors where there are disorderly people? Has the Minister ever witnessed the drunkenness, intimidation and violence on a Saturday night in accident and emergency departments? Does he agree that after ten years of massive wealth and extra finances, it is criminal that the accident and emergency issue has not been sorted yet? How long will it take for the Minister to sort this problem out for once and for all?
I will answer the easiest question as to whether I have ever experienced Saturday nights in emergency departments. I have experienced them numerous times because I worked in them. However, that is not to make light of the situation where people feel threatened — both staff and the people lying there ill and distressed. The drunken and violent behaviour of some of our citizens is not acceptable. The real issue is a health service that has not been functioning and has not been joined up.
In order to answer the question in a comprehensive fashion, it is very clear that we need to reduce the inflows into emergency departments by having more prevention and more chronic illness care in the community along with more early diagnosis and treatment. Family doctors should have access to X-ray, ultrasound and blood testing to diagnose and treat patients so that they do not end up in the emergency department. When they end up there and once a decision is made to admit, there ought to be a bed in the hospital to which that patient can go. We are looking for ways to achieve that because not only do we have the beds that have been closed, as Deputy Kelleher has pointed out, but we also have a host of other beds unavailable because of delayed discharge, where people are awaiting placement in the community. I have a team examining the issue to determine how we can alleviate the problem particularly in urban areas where the problem is most acute. Furthermore, downstream we also need to have more rehabilitation in the community. We are going out into the field to get quotes for those services from nursing homes so that we can expedite the passage of patients through the system.
As I mentioned earlier, the medical care programmes are considering how to discharge patients earlier and the mechanisms of how hospitals work. These are basic time and motion studies to help move patients through quickly. People do not want to be in hospitals any longer than they need to be as we all know.
The Minister said he hoped last winter's situation will not be repeated. How does he intend to deal with that? He mentioned preventive measures and the community response issue, but how is it possible to stop people getting into a violent situation at 10 p.m. or 11 p.m. on a Saturday night entering hospitals when there is no GP service? Part of the solution is that we must have the beds to provide for the patients.
The Deputy has asked a series of questions and I doubt if I can answer them all in the time allocated to me. There are some things we can do to alleviate the situation in the very short term over the next few months; there are other things we can do in the more medium term for the winter; and then there is the longer-term solution which I have outlined already. In answer to the question as to how to stop people getting involved in violence, with no disrespect——
I am referring to people turning up at the hospital.
—— they turn up at the hospital because they have been injured and I suppose they need hospital care. If it is an issue that would be more appropriate for them to attend a general practitioner service, that is something we are also looking at. The reality is that if there has been a fracas and there are suspected fractures etc., without having diagnostics in the community they will turn up at emergency departments.
