Vol. 745 No. 4
43 Deputy Seán Crowe asked the Minister for Health if he will outline the extent of co-operation, if any, between his Department and the Department of Education and Skills on children with autism; and if he will make a statement on the matter. [32964/11]
The Department of Health, the HSE and the Department of Education and Skills co-operate on a regular basis in progressing disability issues. In 2006 a cross-sectoral team was established to provide for a joint approach by both Departments to the implementation of the Disability Act 2005 and the Education for Persons with Special Educational Needs — EPSEN — Act 2004. The team includes senior officials from both Departments, as well as representatives from the HSE and the National Council for Special Education.
As the Deputy may be aware, Part 2 of the Disability Act 2005 was commenced for children under the age of five years on 1 June 2007. It had been intended to have both the Disability Act 2005 and the EPSEN Act 2004 fully implemented during 2010 in respect of children and young people between the ages of five and 18 years. In the light of financial circumstances, however, further implementation of the Acts was deferred in 2008. Notwithstanding the deferral of further implementation of the Acts, the cross-sectoral team continues to meet to address issues of mutual concern for people with disabilities, including children with autism.
The HSE is undertaking a national review of autism services. The review will identify the core principles of service delivery and standards of practice that will guide national autism services in the future. The aim is to review current models of service provision, make recommendations on preferred models of service delivery, and identify clear and consistent pathways for access to services for children with autism. It is expected that the final report will be presented to the board of the HSE shortly.
The review will be taken into consideration in framing future policy developments on autism. The issue of strengthening co-operation between the Department of Education and Skills, the HSE and the Department of Health on policy and operational matters for children with autism will also be examined as part of this process and necessitate further discussions between all parties. I have raised these issues with the Minister for Education and Skills and the Minister for Children and Youth Affairs as part of this process. It is our intention to appoint a person at principal officer level to co-ordinate this work across the three Departments.
I acknowledge that the Minister has long had an interest in this area. I refer specifically to 12 February 2008 when his party brought forward a progressive motion calling for enhanced co-operation between the Department of Education and Skills and the then Department of Health and Children to ensure children with special needs would receive adequate support in all aspects of their lives from an early age. The Minister made a contribution to that debate, in which he said he was focusing specifically on the area of applied behaviour analysis, ABA, education for children with autism. He said: "Natural justice, humanity and fairness demand that ABA is made available to those——
Could the Deputy ask a question, please?
There is a question; of course, there is a question.
The Minister stated:
Natural justice, humanity and fairness demand that ABA is made available to those for whom it is the most appropriate mode of treatment. Early assessment is essential. It is nonsense to have speech and language therapy for the education of young children solely under the remit of the Health Service Executive when clearly the Department of Education and Science should have access to it.
My question is that, in calling for closer co-operation and recognising that the Department of Education and Skills intends to close down ABA, which is actual evidence of a continuation of the approach of the former Government——
Could the Deputy ask the question, please?
Will the Minister, given his long record of interest in this area, help ensure through the dialogue that ABA will be protected and secured as an option for those children for whom it is by far the best mode of address?
This area requires closer co-operation between the Departments of Education and Skills, Children and Youth Affairs, and Health. That is why I proposed to my ministerial colleagues that we should have a principal officer appointed across the three Departments, with the lead coming from the Department of Health. They have accepted this in principle. The matter has not been finalised but is close to being finalised. I hope this will inform all parties on the needs of children with autism and other disabilities. The principal officer should cover all disabilities associated with children.
I certainly look forward to co-operation leading to greater availability of a wide range of services to children with autism. I hope the issue of ABA schools will be among those being considered.
I welcome the Minister's last comment and must interpret it as positively as possible. In July 2010, just last year, the Minister accused the then Minister for Education and Science and the Department of bullying tactics and of forcing ABA schools to sign up to the transition to special school status, thus ceasing to provide ABA to the cohort of children who would benefit. I hope the Minister's response has indicated his position has not changed.
What will be done to address the shortage of speech and language therapists and the failure to replace therapists on sick leave and maternity leave? The shortage is such that the children affected miss out on months of educational input that is crucial to their early development.
We are certainly seeking to protect front-line staff in that area. We are discussing the moratorium in terms of flexibility regarding key positions of the kind in question. I am aware of circumstances in which we have not been able to provide the speech and language services and behavioural therapy that should go with the classes provided. I am addressing this internally in the Department at present.
44 Deputy Mick Wallace asked the Minister for Health if he will provide a detailed timeframe for the expeditious implementation of the European Court of Human Rights judgment in the A, B and C case committed to by the Government at the UN Human Rights Council hearing in Geneva on 6 October 2011, including exact dates for the establishment of the expert group and the conclusion of their work; his response to their proposals; if he will provide a detailed explanation for the rejection of six recommendations from European countries relating to abortion; and if he will make a statement on the matter. [31262/11]
73 Deputy Mick Wallace asked the Minister for Health if he will explain the reasons behind the refusal to accept six recommendations from European countries that Ireland should legislate for abortion; if he will explain in detail the timeframe for the expeditious implementation of the European Court of Human Rights judgment in the A, B and C cases committed to by the Government at the UN Human Rights Council hearing in Geneva on 6 October 2011; specifically if he will provide the date in November by which the expert group will be set up, the date by which the expert group will be expected to transmit proposals to him, and the date by which he will respond to these proposals; and if he will make a statement on the matter. [31263/11]
I propose to take Questions Nos. 44 and 73 together.
I assure the Deputy that the Government is committed to the implementation of the action plan on the ABC v. Ireland judgment. As the Deputy is aware, the Government submitted an action plan to the Committee of Ministers of the Council of Europe on 16 June 2011, as required by the European Court of Human Rights. The action plan outlined the following commitments by the Irish State. Ireland is committed to ensuring the judgment in this case is implemented expeditiously. The Government will establish an expert group, drawing on appropriate medical and legal expertise with a view to making recommendations on how this matter should be properly addressed. It is intended that the expert group will be established by the end of November 2011. Following the recommendations from the expert group, proposals will be drafted and transmitted to the Government for approval and, by the end of 2011, an action report will be filed outlining the expert group’s detailed terms of reference, membership and meeting schedule. As stated in the action plan, the Government is committed to the establishment of an expert group on the ABC v Ireland judgment to make recommendations on how this matter should be properly addressed. My officials are in the process of finalising the work required to establish this body. The Government rejected all recommendations on this issue submitted to the State during the universal periodic review process in Geneva on 6 October, as it would be inappropriate for it to pre-empt the recommendations of the expert group at this stage. In the case of the recommendations made by Denmark and Slovenia, these were outside the scope of the judgment and not in line with Article 40.3.3° of the Constitution of Ireland.
As I am sure the Minister is well aware, almost 20 years have passed since the X case and we have watched Government after Government kick the can down the road and refuse to have the courage to deal with this issue. We are talking about a human rights problem which we have been content to export rather than deal with it head on, as we are afraid of what the public might think. We have been afraid to do the right thing. We compare Ireland to other countries in Europe, but 44 of the 47 countries in Europe are way ahead of us on this issue in respecting the right to health of the pregnant woman.
The Deputy should put a question to the Minister.
Irish abortion law denies women the most fundamental right to live in dignity and to self-determination and the opportunity to exercise these rights without discrimination in that having an abortion is criminalised in almost all circumstances. Elsewhere in Europe the approach adopted is consistent with the standard of proportionality in key human rights which requires that laws and policies applied to regulate access to abortion services cannot excessively interfere with a woman's rights to life, health, privacy, freedom from cruel and inhumane treatment and non-discrimination.
The Government has been in office for nearly one year. I would have thought that the Minister would have considered this matter to be a top priority, one that needed to be dealt with quickly. Is he telling me that the expert group is still in the process of being set up? When it is set up, will he publish the names of its members, outline the reasons for their selection and the terms of reference? It would be interesting to have that information because it goes without saying the group which will be selected will have considerable influence on the final decision to be made.
The Government has many priorities. While this is a hugely important issue, the survival of the economy and the maintenance of a reasonable health service are but two priorities with which we are dealing on a daily basis. Notwithstanding this, we gave a commitment in the programme for Government that we would form a special advisory group and when that group is in place, the names of its members and its terms of reference will be made public.
May I ask a supplementary question?
Yes, but it has to be brief.
On what issue does the Minister need an expert? This is the reality for thousands of Irish women every year.
The Deputy should put her question.
On what issue does the Government need to deliberate? What expertise does it require? More than 20 years ago the people voted on the right to abortion, albeit in limited circumstances. Can the Government not simply enact legislation to deal with the reality for thousands of Irish women every year? What is the reason for the delay and why does the Government require expertise to deliberate on the issue further?
As the Deputy is well aware, this is a very sensitive and thorny issue for many people. It is also divisive. The judgment is clear and we have given a commitment to meet its terms. We will obtain the best advice available to us in the form of an expert group, the terms of reference of which will be published. The group will publish its report which will be available to everyone to examine and give us the best advice available. That is only right and proper.
Is it not the case that the advice of the people is that they have voted on this matter twice already? In terms of the Supreme Court judgment and the previous ruling in the X case, the people have voted to allow abortion in Ireland, albeit in limited circumstances. However, the Government has not yet drafted the heads of a Bill to deal with the issue.
The Deputy is correct to say the Irish people have voted twice. The interpretation of this court case is a separate issue pertaining to how that is to be put into place. The matter is not as simple as she would like to paint it.
Twenty years.
45 Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will put in place an emergency plan for hospitals to accommodate the predictable surge in activity that occurs every winter; and if he will make a statement on the matter. [32717/11]
46 Deputy Willie O’Dea asked the Minister for Health when the recommendations of the special delivery unit in the accident and emergency department in the Mid-Western Regional Hospital, Limerick, will be implemented; and if he will make a statement on the matter. [32979/11]
59 Deputy Denis Naughten asked the Minister for Health the steps he is taking to address the overcrowding crisis at Galway University Hospital; and if he will make a statement on the matter. [32713/11]
71 Deputy Luke ‘Ming’ Flanagan asked the Minister for Health if his attention has been drawn to the overcrowding which occurred at the accident and emergency department of National University of Ireland Galway Hospital on the 24 September; if his further attention has been drawn to the fact that the hospital was forced to appeal to the public, via local radio stations’ news bulletins, not to bring emergency cases to the accident and emergency department of NUIG hospital on 24 of September; his views that this overcrowding is unacceptable and a danger to health and that the extra burden placed on the accident and emergency at NUIG hospital is in part due to its vastly increased catchment area due to the closure of Roscommon County Hospital accident and emergency ward; and if he will make a statement on the matter. [32712/11]
85 Deputy Gerry Adams asked the Minister for Health if he will urgently address the critical situation in hospitals in the north-east region, including record numbers of patients on trolleys in Our Lady of Lourdes Hospital, Drogheda, this autumn; and if he will make a statement on the matter. [32962/11]
I propose to take Questions Nos. 45, 46, 59, 71 and 85 together.
I have said clearly on many occasions that the situation in our hospital emergency departments, where people must wait for unacceptably long periods on trolleys, will not be allowed to continue. For this reason, as I have already outlined to the House, one of my first actions as Minister for Health was to set about establishing the special delivery unit.
The problems in our emergency departments are complex and did not arise overnight. The issues vary from hospital to hospital and some of the solutions will depend on local factors. Delayed discharge, for example, is an issue in some parts of the country but not in others. A common factor is the need for reliable real time information, agreed standards for safe care and relentless performance management against those standards.
Following considerable analysis of the problems in individual hospitals, I recently approved an initiative whereby funding will be made available to ease pressures in certain emergency departments. The supports being funded are dependent on certain conditions and the money will be released based on specific performance. The supports may involve providing funding for smaller hospitals in the group to ease pressures on the major centre. As I have frequently said, I want to ensure that as many services as possible can be provided safely in smaller local hospitals.
In the case of Our Lady Of Lourdes hospital, Drogheda, the hospital has requested a range of supports and the special delivery unit has agreed to a set of proposals which will cost more than €700,000 between now and the end of this year. More than €300,000 is being made available to Galway University Hospital. The special delivery unit has indicated to me that considerable improvements can be made at Limerick hospital within existing budgets and I have requested the HSE to implement these changes. These include some reallocation of existing staffing resources, a better bed management system and the shifting of day case capacity to other hospitals in the group. The issue of further support for Limerick is under consideration by the special delivery unit.
The HSE has indicated that the impact of the emergency department changes introduced at Roscommon County Hospital in July 2011 has been marginal. The figures for the three month period to the end of October indicate an increase of 127 patients at Galway during this period, which is equivalent to ten additional patients per week or less than two per day.
Peaks and troughs are a feature of attendances at emergency departments. The special delivery unit is working with hospitals to use the data on attendance patterns to plan for the variations which will inevitably occur. At my behest, the unit is driving this approach to radically reduce the overcrowding in our emergency departments which has been tolerated for far too long.
During the course of the general election last February, the Minister stated that his party would put in place an emergency plan to accommodate the predictable surge in activity that occurs every winter. According to the figures for Our Lady of Lourdes Hospital in Drogheda, 842 patients spent time on trolleys in that hospital in September. The figure for the previous September was 331 which, unacceptable as the situation was under the stewardship of Fianna Fáil, implies an increase of 154% in the utilisation of trolleys in the hospital. How will the Minister address an impending winter crisis against the backdrop of that serious increase in trolley usage without lifting the moratorium on front line service providers and addressing the crisis resulting from the closure of public hospital beds, an issue he once raised with regularity but has been in denial about since being appointed to office? The two issues are directly related to the crisis that I fear will reach unprecedented proportions this winter.
The Deputy is correct to note that I raised these issues while in Opposition. I guarantee him that the special delivery unit is keeping a close eye on all these hospitals and it is reporting to me on a weekly and, sometimes, a daily basis. The provisions we are putting in place have been recommended by the hospital itself. We have priced them and they are only being made available under strict conditions. Certain other arrangements, including weekend discharges and diagnostics, will also have to be put in place. We are getting to the point where we can see what is happening on a daily basis and we can institute reforms in a more rapid and targeted way than in the past. The matter remains under review and, if the initiatives we have undertaken to date do not deliver the results we desire we shall look to initiate other processes to help address the situation.
The Minister suggested that the changes which took place at Roscommon hospital have not caused a problem for Galway University Hospital. If that is the case, why was a bulletin broadcast on local radio stations on 24 September to warn people against going to the emergency department? If the replacement cover is so good why did one of my constituents discover after calling an ambulance that the paramedics could not even put in a line? If not for the fact that the patient's mother could perform that task, her child might not be with us.
Does the Minister really think it a success or is it solely a matter of money? I acknowledge he is not responsible for the mess that the last Government made but is this just about money?
I acknowledge the concerns expressed by the Deputy regarding Roscommon hospital. However, I have investigated with HIQA and the HSE every option for keeping the hospital. I was told it was not safe to keep the emergency department open and that is the long and the short of it.
I stated previously that I will be honest with the House in indicating whether a decision is based on safety or matters of money. I am willing to admit to Deputy Ó Caoláin that the issue in Monaghan is budgetary in nature rather than about safety. The issue in Roscommon involved safety, however. The situation in Roscommon is unlike the situation in Our Lady of Lourdes hospital. The situation is far worse than in Galway University Hospital.
We experience surges but it is interesting to note that the special delivery unit discovered that a major surge does not occur in January. The tremendous problems that have arisen in the month of January were caused by a combination of people returning from holidays and increased activity in elective surgery, allied with what is there already.
Specific initiatives are being taken in Galway and new management is being put in place. Recent appointments have included a new chief financial officer and chief operations officer, and a new CEO will also be appointed as part of a wider initiative including Limerick mid-west to allow for upskilling across HSE west hospitals.
The Minister referred to continuing monitoring but has he a plan? We are well into November and there is already ample evidence that the situation is worse now than it was 12 months ago. We need a plan that includes a means of addressing the moratorium on front line service providers and a programme for lifting the closure orders on beds in a number of hospital sites around this state.
Can the Minister tell us that he has a plan and that he will be in a position to respond if the numbers grow exponentially in the coming weeks?
I will take the contribution from the Deputy in the spirit in which it is offered. There is a plan and I have outlined some of it to the Deputy. It is being implemented and must be given time to work. If we are not achieving the desired effect when we review it a number of weeks hence, we will take further initiatives. The plan covers much of what the Deputy has mentioned. Beds have been opened in Louth County Hospital and Navan hospital to relieve the pressure in Drogheda. All these issues have been addressed. In addition, eight beds within the hospital have been opened. These things are happening and we must give them time to take effect. We will keep the matter under active and close review.
The Minister mentioned patient safety at Roscommon County Hospital and HIQA. In fact, HIQA representatives did not visit the hospital and produce a specific report on it, although the impression is given that they did. Also, when the campaign to keep the accident and emergency department open was at its height, figures were produced to show that the hospital was somehow four times more dangerous for people having a heart attack and with other conditions, but nobody produced concrete evidence to show that this was the case. Many would deny that it was any more dangerous than the hospital in Galway.
The figures will be made available. I understand the report is to be published in the next few weeks and the Deputy will then have an opportunity to scrutinise the figures. However, I must restate the decision of the HSE to close the emergency department, on foot of HIQA's recommendation, was based on its assessment of the position prior to any of those figures becoming available. The figures emerged in the course of the debate as further evidence that there was a problem, but that was not the basis on which HIQA made its decision that it was not safe to continue the emergency department in Roscommon in its form at the time.
The Minister says the closures can be justified on safety grounds. On 19 April 2009, shortly after the accident and emergency department in Ennis was downgraded to providing an 8 a.m. to 8 p.m. service, Mr. Dan McConnell, a 59 year old father of three, died just minutes away from Limerick hospital. He had suffered a heart attack in Kilkee, 34 miles from Ennis——
Is the Deputy putting a question to the Minister?
Yes. It was 34 miles from Ennis but 59 from Limerick. In other words, he died because the hospital in Limerick was further away. The closure of local accident and emergency departments in hospitals costs lives. That is the health and safety issue. What is the Minister's response?
It is very straightforward. As I do not wish to show any disrespect to an individual, I will not discuss the individual case mentioned. The supposition on the Deputy's part that somebody might have survived had they gone to the hospital in Ennis which did not have the backup support that was available in Limerick is erroneous and not factual by any means. All the evidence shows that survival is predicated on getting to the right type of hospital, even if it takes longer than one hour, which has the ability to assess the problem, thrombolyse the patient and insert a stent, if necessary.
Therefore, the response times mean nothing.
The response times are always important, but they are not the be-all and end-all. For many years we talked about the golden hour, which originated from field medicine in a war, but it is now outmoded and long gone, as any expert emergency doctor or consultant in this country will confirm.
47 Deputy Michael Moynihan asked the Minister for Health the relationship and chain of command between his advisers and the Health Service Executive; and if he will make a statement on the matter. [33003/11]
The provisions governing the appointment and role of special advisers are set out in section 11 of the Public Services Management Act 1997. In summary, the role of special advisers is to assist the Minister by providing advice; monitoring, facilitating and securing the achievement of Government objectives that relate to the Department; and performing other such functions as may be directed by the Minister that do not involve the exercise of specific powers conferred on the Minister or other officeholders.
In order to perform their functions, it is important that my special advisers are kept up to date on developments within my Department and the health service generally both by officials in my Department and other agencies, including the HSE. It is also important that information is shared with the special advisers and every effort should be made to keep them briefed on significant issues.
Special advisers are not part of line management in the Civil Service. Accordingly, the briefing of special advisers should be regarded as complementary to the direct briefing of the Minister. It cannot act as an alternative to the direct briefing of the Minister on important areas of policy and operation. While my special advisers have no executive functions, it is reasonable for me to expect that they are kept fully briefed on any issues that relate to my role as Minister in order that they are in a position to provide me with informed advice.
I raised this issue previously in another question. There are conflicts between what is being said in the House and what is contained in e-mails from special advisers in the Minister's Department. Without giving names and specifics, e-mails have been sent from the Minister's advisers "with the full authority of the Minister". The advisers either have the full authority of the Minister or they do not. They are circumventing the chain of command and now making recommendations to the HSE with the full authority of the Minister. However, the Minister comes to the House, quotes the Act and claims that they do not have that full authority. Clearly, the Minister's special advisers are acting outside their remit when they can send e-mails to Ms Laverne McGuinness, Mr. Pat Healy and the HSE stating they are acting with the full authority of the Minister.
Does the Deputy have a question for the Minister?
Who is in charge of the health service? Who is running it? Do the advisers have the authority to tell the HSE and its managers that they are acting with the full authority of the Minister? Can the Minister give a "Yes" or a "No" answer?
I have already indicated who is in charge of the health service — the Ministers of State and I take that responsibility.
Is the Minister taking responsibility now?
Let me finish. The Deputy has asked who runs the health service. Clearly, I do not run it. I take responsibility for it, but it is run by the HSE and there is a chain of command through the Department for policy.
Last year the Minister was going to sort them out.
Please allow the Minister to answer the question.
With regard to advisers, if I ask my adviser to pass a message or instruction to an individual in the HSE, I see no issue with this. It is the same as me picking up the telephone and saying it myself. There will be specific times when they will be asked specifically to make a request or send a message to an individual. That is entirely different from giving somebody authority across the entire system. The Deputy will find that there have been specific issues, but there is no general ability to instruct or do otherwise.
Is the practice still in place whereby advisers, acting on behalf of the Minister, can, with the full authority of the Minister, infer decisions should be made or taken without formal discussions or going through the proper procedures at the HSE, the board and along the chain of command? Do advisers have the authority to put the reconfiguration process on hold, for example, as was stated by one of the Minister's advisers? Clearly, that is not within the remit of the adviser, as the Minister has stated.
I believe the Deputy is alluding to a specific instance in which I had already informed the chief executive officer of the HSE that there should be no further changes without bringing matters to my attention in order that I could study their implications. There might have been times when that message had to be reaffirmed, and this was done through an adviser. I do not see an issue with this. The original instruction came from me and through the Department of Health. In fact, the Secretary General wrote a letter to the HSE advising it of the position. The fact that an adviser might have had to reinforce this subsequently is not a source of grave concern as the Deputy is trying to make out it is.
The CEO had that view.
My point is to focus on whether the aforementioned advisers are advisers to the Minister. I refer to the leaked letter, to which the Minister has just referred, from the Secretary General of the Department of Health to Mr. Cathal Magee, the chief executive officer of the Health Service Executive, HSE. That letter stated it was regular practice to accept "a particular suggestion from an adviser" in place of seeking a formal decision directly from the Minister. Is that the way in which to operate a health service? What does that say to people about who is at the helm of the health service? There is no indication whatsoever that there was any engagement with the Minister. It was the adviser's position, leaving the Minister out of the frame.
Is that the Deputy's question?
That is precisely what it states and this appears to be most casual.
We are out of time now and we want to get in another question.
Can the Minister assure Members that he is, as he suggested he would be when he took up office, both accountable and responsible for the health services?
The Minister, in a brief response.
I cannot get more brief than "Yes".
Members will be obliged to judge the Minister on his record.
48 Deputy Richard Boyd Barrett asked the Minister for Health if he will provide a progress report on the reconfiguration of health services in south county Dublin; if a decision to downgrade the Loughlinstown hospital accident and emergency to an 8 a.m. to 8 p.m. minor injury unit has been agreed and if there is a planned date for same; and if he will make a statement on the matter. [33032/11]
I am preparing a framework for the future development of smaller hospitals, which includes St. Columcille's, Loughlinstown. The HSE and my Department are working with the Health Information and Quality Authority, HIQA, on the safety aspects concerned. As I stated earlier, consultation covering all the key stakeholders, including patients and public representatives, will be an integral part of the process. The three hospitals in the region, namely, St. Michael's, St. Columcille's and St. Vincent's, are working together with the HSE to ensure the appropriate level of service is provided in the best location to ensure clinical safety, quality and patient safety and to manage risk. As for the reconfiguration of emergency department services in the integrated service area, a project steering group is reviewing the current service provision and is in the process of generating proposals as to how the new service configuration will operate.
While I have been asking this question for six months, I still am no closer to getting an answer from the Government as to whether it plans to downgrade the accident and emergency service in Loughlinstown hospital. The people of Loughlinstown and south County Wicklow seek an answer and a timeframe as to when the Minister will publish or announce his plans or recommendations. I appeal to the Minister not to downgrade the accident and emergency unit at Loughlinstown hospital. I note the Minister has stated this is all about safety. A total of 21,000 people go through the accident and emergency unit at Loughlinstown hospital each year and were it to be downgraded to a minor injuries service operating from 8 a.m. to 8 p.m. and if, at a conservative estimate, half or even 10,000 of them were to be pushed down to St. Vincent's Hospital, this would mean the attendance of an additional 28 people per day at that hospital's accident and emergency unit. As 31 people already were on trolleys in that hospital yesterday, this does not add up because as matters stand, St. Vincent's Hospital cannot cope.
Does the Deputy have a question?
If one pushes thousands of accident and emergency cases on to St. Vincent's Hospital, which already is in chaos, there will be more chaos, suffering and lives lost. I appeal to the Minister to do in his review what the people of south County Wicklow and Loughlinstown want, which is to retain the 24-hour accident and emergency service in Loughlinstown hospital and if safety issues exist there, to put the requisite resources into it.
Hear, hear.
Deputy Boyd Barrett would be correct in his assumption of the additional thousands turning up at St. Vincent's Hospital if it was the case that they could not be seen at Loughlinstown.
I suggested half of the 21,000 people.
It will not be half. First, the numbers of people who attend after 8 p.m. are quite small. Second, most of the patients can still be catered for in a minor injuries or urgent care centre. Only cases involving serious multiple trauma, undifferentiated chest pains and acute abdomen pains end up going to St. Vincent's. Consequently, the numbers will be nothing like those which the Deputy suggests. I will publish the framework document and as a public representative, the Deputy will have an input into the draft. He will not have a veto on it — no one will — but people have a right to be informed, to have a consultation process and to be allowed to make an input into the document. This will happen and already has been outlined. The process has been a little slower than had been anticipated but it is better to be a little slower and to have agreement and to get it right than to rush in and to have regrets.
The Minister still has not informed Members when they will get a chance to be consulted on this issue or when his recommendations for the so-called reconfiguration of services will be out in the public domain. Moreover, the Minister is not answering the question about how St. Vincent's Hospital already is unable to cope on a daily basis. He appears to suggest the downgrading of the accident and emergency service at Loughlinstown hospital, both what it does and the hours it will be open, will have no impact on St. Vincent's, which already is overrun. This does not add up.
I must beg to differ with the Deputy opposite, as it does add up. What is required is for appropriate services to be available in the appropriate setting and that they are safe. I have made the point previously that there has been much talk about what has gone out of small hospitals. However, one should wait for the rows that will take place when we begin to take stuff out of the bigger hospitals to put it back into the smaller hospitals. People attending major hospitals such as St. Vincent's or Beaumont for inguinal hernias or varicose veins is akin to sending one's ten year old Volkswagen up to the Ferrari testing centre. While it will do a great job, the local garage would do it just as well and a great deal more efficiently and conveniently. My point is the more complex cases will be left for the secondary and tertiary hospitals, while the smaller hospitals such as Loughlinstown and others will deal with a far wider range of problems in respect of procedures, including cataract surgery and various other day case surgery that can take place. Moreover, each small hospital is different and sits in a different place with regard to the overall hospital network in which it is located. For instance, Roscommon hospital would have a different range of procedures carried out than might the likes of Loughlinstown hospital. I again revert to Louth County Hospital, in which the footfall has greatly improved.
Does this mean the Minister has already decided without consultation?
Please allow the Minister to respond.
No, not at all. I told the Deputy there would be a consultation process. There is a menu of approximately 24 different types of procedures that can be carried out safely at present. However, this is a dynamic situation and this list may be added to next year as things change, as medical procedures and surgical techniques improve and as more stuff will leave the bigger hospitals for the smaller hospitals. Moreover, more activities will leave the smaller hospitals to go back into primary care. It is all about treating the patient at the lowest level of complexity that is safe, timely, efficient and as close to home as possible.
All those who can afford to will be running off to theBeacon Clinic.
