Dáil Éireann debate -
Thursday, 6 Oct 2022

Vol. 1027 No. 3

Saincheisteanna Tráthúla - Topical Issue Debate

Healthcare Infrastructure Provision

Deputy Kieran O'Donnell

I raise the need for an elective hospital in Limerick. It is already Government policy that Cork, Galway and Dublin will get elective hospitals, and it is completely illogical that Limerick and the mid-west are not included. There are a couple of reasons for that. I have been a public representative of Limerick for many years. We have the highest number of people going through the emergency department, ED. In 2021, Limerick had the highest number of patients going through the ED in any one year, while it is predicted that almost 80,000 people will go through it this coming year. Furthermore, we have the lowest number of open beds per 1,000 of population of any region.

Cork, Galway and Dublin all have private hospitals. We have no private hospital at the moment, even if we will have one in the future. The lack of an elective hospital is illogical given Limerick has been the place with the highest number of people on trolleys over a recurring period. Thankfully, the numbers today are down. Nevertheless, while they are not at their highest level, they are still high.

This is pretty straightforward. The Taoiseach has stated in recent days that he now believes that the case for an elective hospital in Limerick is compelling.

I want to see about getting a process under way. An elective hospitals oversight group has been established to progress the elective hospitals in Cork, Galway and Dublin. I want to see the Minister for Health now direct it to start scoping for an elective hospital for County Limerick. This is the process I want to see around that. We have University Hospital Limerick, UHL. St. John’s Hospital in the heart of the city has a proposal in at the moment. It is already an elective hospital, in many ways. It has a proposal in to increase the number of beds from 90 up to 150. UPMC has also brought forward a proposal for an elective hospital. This needs to be scoped. I want an agreement in principle from Government that it will now make a Government policy that Limerick will have an elective hospital. Part of that has to involve the consideration of what St. John’s Hospital can bring to the table. We need to evaluate the UPMC proposal as well.

The process, which I have looked through, is very straightforward. The Government and the Minister for Health need to direct the elective hospitals oversight group, which has joint governance under the Department of Health and the HSE, to now include the scoping out of an elective hospital in Limerick along with what it is doing in Cork, Galway Dublin. Otherwise, it is incomplete. I would certainly question the methodology that was used that gave rise to elective hospitals in Cork, Galway and Dublin and none in Limerick. It is illogical to me. We have to move to the next step.

The Taoiseach came out and firmly stated that he now sees the compelling need. He said he will go to the Minister for Health to fast track it. I am now putting forward what the process is, which is that the Minister for Health instructs the elective hospitals oversight group to start the scoping exercise as to what form the elective hospital in Limerick will take. When it goes to the elective hospitals oversight group, however, it should be Government policy that there will be an elective hospital in Limerick.

Minister of State at the Department of Health (Deputy Anne Rabbitte)

I thank the Deputy for raising this Topical Issue matter today, which I am taking on behalf of the Minister, Deputy Stephen Donnelly.

As the Deputy is aware, the cross-party Sláintecare report in 2017 articulated a new vision for healthcare in Ireland, including the provision of elective only hospitals and providing protected capacity for elective care. This policy has also been informed by a number of subsequent policy documents and Government decisions including the 2017 Sláintecare report, the Sláintecare implementation strategy and the national development plan in 2018, the programme for Government in 2020, the Sláintecare Implementation Strategy and Action Plan 2021-2023 and, finally, the new national elective ambulatory care strategy, which was agreed by the Government in December 2021.

This new strategy aims to change the way in which day cases, scheduled procedures, surgeries, scans and outpatient services can be better arranged to ensure greater capacity in the future and help to address waiting lists at a national level. The development of additional capacity will be provided through dedicated, stand-alone elective hospitals in counties Cork, Galway and Dublin.

The elective care scope of service will be developed in two phases commencing with day cases, diagnostics and outpatients, and then by inpatient treatment. On this basis, the elective care centres will be designed to provide sufficient capacity to facilitate further phases, including some elective inpatient capacity, thereby providing a sustainable and strategic response to cater for the highly dynamic landscape of healthcare policy and practice.

It is important to note that the locations chosen will allow for new facilities of a size and scale to implement a national elective care programme that will tackle waiting lists on a national basis. This means that the new facilities will be designed to maximise their capacity and, in doing so, will operate to meet the demands of as wide a catchment area as possible, extending beyond existing and future health areas including the mid-west. The Minister, Deputy Stephen Donnelly, is conscious of the desires expressed by Deputy O'Donnell for a dedicated elective hospital in Limerick.

I would say to Deputy O'Donnell that the locations were chosen in line with good practice, which suggests that in order to maximise economies of scale, dedicated, stand-alone elective centres should be as big as is reasonably possible to meet identified demand while providing appropriate population coverage. Locating the new facilities in counties Cork, Dublin and Galway will enable the provision of a national service while aiming to maximise the coverage of the elective care centres as far as is reasonably possible.

A central point of introducing these new facilities is not that they will only benefit the subset of the population that sit within their direct catchment, but rather that the introduction of a new delivery capability into the public healthcare system will benefit the whole population, including those who do not fall within the immediate geographical catchment.

An additional elective facility in Limerick would have a minimal impact on population coverage relative to the significant increased investment to build and operate. The Minister expects to bring an update to the Government very shortly and the preliminary business cases will be published when approved by the Government. I hope that when they are published, the significant and material benefits for the people of Limerick and the mid-west will be evident.

Deputy Kieran O'Donnell

I have two issues. I mean no disrespect to the Minister of State, Deputy Rabbitte, but I would like to have had the Minister, Deputy Stephen Donnelly, in the Chamber today. He is the Minister with primary responsibility; he should have been here.

Second, I wholeheartedly disagree with the Minister for Health's comment that an additional elective facility in Limerick would have minimal impact population coverage relevant to a significant increased investment to build and operate. From what I can see, other jurisdictions that have the elective hospital cannot even decided on a site. They are openly arguing. We have options on the table, namely, St. John's Hospital and UPMC, maybe with both working together. In my view, that subject has to be looked at.

The bottom line here is that this is a Government decision. This is at variance with what the Taoiseach said publicly both in the Dáil and outside. He said there is a need for an elective hospital unit. The case is compelling. This particular response seems to completely ignore the fact that we have had a performance management unit in UHL for the last number of months. We have the highest number of patients presenting to the emergency department in the country. We had 80,000 this year. Second, our emergency department attendees-to-bed ratio is by far the highest in the country. The case is, therefore, compelling. I have looked at the process. Under the Sláintecare national elective ambulatory care strategy, the elective hospitals oversight group was challenged with basically scoping out the elective hospitals in Cork, Galway and Dublin. It needs to be directed by the Minister for Health, in line with the commitment from the Taoiseach, to now include Limerick as well.

Our system in Limerick is under enormous pressure. The recently published Deloitte report stated that we will need 300 additional beds by 2026. At the moment, we need 200. We have 96 being built; we need another 90 more or less straight away. There are options on the table that would effectively involve an enhanced elective hospital at either St. John's Hospital or UPMC on the ground very quickly.

I very much want the Minister for Health to take up this issue now and have discussions with the Taoiseach in terms of what the Taoiseach said publicly. We need to get this elective hospital for Limerick included as Government policy and get the scoping from the elective hospitals oversight group under way.

Deputy Anne Rabbitte

I thank the Deputy for raising this important issue. As I said in my opening remarks, I am conscious of Deputy O'Donnell's desire for new elective facilities in the mid-west. However, I would stress to him that the new facilities that are planned for the three locations in Cork, Dublin and Galway should be considered as national assets that will introduce a new delivery capability into the public healthcare system, which will benefit the whole population to the greatest possible extent.

I am conscious of the remarks made by the Taoiseach earlier this week in response to a proposal for elective facilities in Limerick. I fully agree with the Taoiseach that progressing the elective hospital route is the way to go. We are taking all steps to fast track this proposal within the current rules. By introducing new capacity, we can tackle waiting lists in the long term and free up hospital capacity in the existing wider public hospital network. To conclude, I would note again that I hope Deputy O'Donnell will see the clear benefits that Limerick, the mid-west and the country as a whole will see through the development of these new world-class elective hospitals.

Deputy Kieran O'Donnell

Can I just say-----

Acting Chairman (Deputy Bernard J. Durkan)

I am sorry. The Deputy cannot-----

Deputy Kieran O'Donnell

I welcome the comments from the Taoiseach in the Minister of State's response. It is something we will be following up on.

Acting Chairman (Deputy Bernard J. Durkan)

We cannot set a precedent; I am sorry about that. If the rules change we will accommodate that.

Home Care Packages

Deputy Pat Buckley

I thank the Minister of State for being here. This Topical Issue matter is practically self-explanatory. For the past number of weeks I have been making representations on behalf of some constituents of mine on the matter of home help hours and so on. In fairness the Department has come back and sanctioned hours and stuff but the issue is that we do not have staff to fill those hours.

This takes me on to particular incidents and I spent two and a half hours being bounced around Departments yesterday while trying to find somebody who is accountable or responsible or who makes the decisions when it comes to elderly care in the home. I was talking to a family who has a parent in their 90s and they have been told that the number of incontinence pants they use on their parents have been reduced to two per day. I found that highly insulting and degrading for this family and my fear is if it is happening to one family is it happening to others? I did not want to raise it as a Topical Issue matter because of the fact that it is nice to pick up a phone and tell someone this is wrong and ask to get it sorted out. However, as I said I was stonewalled all day yesterday trying to get a response on this.

I have details on this horrible individual case that I will supply to the Minister of State but I want to highlight the fact that somebody from outside this House will have picked this up this evening. Hopefully whoever is responsible for making these decisions can reverse them. We are in here and people are under the perception that we are in the protection of the Chamber or whatever. We all go home and if we are lucky enough to have parents we look forward to seeing them. Surely when you come to the latter stages of your life people would have respect and empathy for these elderly people. I cannot figure out how this individual or collective body has made a decision to cut the likes of a basic necessity and limit it over a possible cost.

I know the Minister of State will not be able to give me a direct answer but I want to make her aware of this. All of us here are expected to know everything that is going on in our constituencies and in the country but we do not. The Minister of State needs to be informed about it and that is why I am informing her that I am afraid because another family asked me not to complain. That makes it even more serious because they are doing it through fear now. If there is fear of cutting back the number of incontinence pants for our elderly then our system is going backwards. I wanted to raise this with the Minister of State so that hopefully the powers that be who are responsible for these moves will reverse it. Hopefully this precedent will never be set again.

Deputy Anne Rabbitte

I assume it is a constituent who came to the Deputy so I can only assume he is talking in the context of community healthcare organisation, CHO, 4. On behalf of the Minister for Health I thank the Deputy for raising this important matter.

The Health Service Executive provides a wide range of medical aids under the community funded schemes to eligible persons, as set out in the Health Act 1970, free of charge following assessment by a relevant health professional. The HSE oversees the provision and supply of incontinence wear products for eligible persons across Ireland. Provision is based on an appropriate clinical assessment and a determination of the most appropriate products that will meet the individual's needs. These assessments are supported by national guidelines and other educational tools that are available to healthcare staff working throughout the country.

The HSE operates a home delivery service which provides incontinence wear products to more than 70,000 individuals living in their homes. This is a person-centred delivery system, which allows the individual or their carer to vary both the time of delivery and the amount of product delivered, according to their specific needs. It is also possible to alter the location for a particular delivery should the need arise. In the past, individuals have at times been provided with too much or too little product, which is not optimal for the individual person or their families, and the system now in place helps to ensure that these issues are now at a minimum. In addition, the HSE has a bulk delivery system in place for community nursing units and other residential care settings. This also operates on the basis of a regular delivery schedule with a facility to adjust both the amount and timing of the delivery. The HSE also utilises the service provided by public health nurses and continence nurse advisers to assess individual patient needs in order to ensure that the supply of incontinence wear products is appropriate.

As part of the national service improvement programme for the community funded schemes, the HSE has completed and implemented national guidelines in respect of incontinence wear products. Governance arrangements have been strengthened through the implementation of an integrated electronic management system to support the ordering, supply and distribution of incontinence wear products across all healthcare settings, including the home delivery service. The provision of clinically appropriate incontinence wear products to eligible persons is operated by each CHO under a national tender arrangement. The HSE views the appropriate provision of incontinence wear products to eligible persons based on need as a success of the improvement programme. In circumstances where a person does not hold full eligibility, such as a holder of a medical card or a long-term illness scheme card, reimbursement support for incontinence wear products is provided under the drug payment scheme, DPS. While there is no set limit on the quantity, the DPS claim must be supported by a valid prescription for such products.

It is unfortunate that the Deputy had to raise this on the floor of the Dáil but what I see here is that there is no limiting but that it is based on clinical need and assessment. When there is a clinical need assessment done, reducing the amount that is available to two per day does not seem appropriate. Perhaps it is something that needs to be taken up with the public health nurse.

Deputy Pat Buckley

I know where the Minister of State is coming from. While I was listening to her I was thinking we should not be bringing these cases up because people have responsibilities and they are in jobs to provide these services. In her response the Minister of State mentioned the DPS. While there is no limit set a valid prescription is a cost to people, which is a separate issue. I refer to the idea of there being "too much or too little product". When it is causing that much stress to a family and they have to go to their Dáil Deputy, who tries all the angles to go through the HSE to try to get this solved and it ends up being discussed in the Dáil, then there has to be a breakdown somewhere. My wife always kills me when I make the following point but is it not better to be looking at it than looking for it? While we are sitting here that family does not have the answers. I will be talking to them afterwards and I will tell them it will hopefully be addressed now.

I know where the Minister of State’s response is coming from and it mentions: "too much or too little product, which is not optimal for the individual person or their families". We talk about carers and they are the individuals who have been involved for the longest length of time so to me they are the experts. If you are dealing with the district health nurse and saying that two, five or ten items is not enough then surely that should be taken on trust. People are not hoarding these products to sell them. I appreciate the Minister of State's response and she is right that I should not be raising this matter here. I am just afraid that if a precedent is being set here and if families and their loved ones are suffering because of the lack of a simple necessity. This could not be taken away from a child for example. I spoke to a mother very recently and I mentioned something about this and she said she did not know how many nappies she was going to use on her child that day. There should be a common sense approach to this and there should be trust between families and the health system.

Deputy Anne Rabbitte

I agree there should be common sense shown in the approach to this issue. There is a middle ground that needs to be achieved, which is called neither "maximum" nor "minimum" but is just common sense. I reiterate that the service provided by the HSE operates on a person-centred, person-specific basis to fulfil patients' clinically determined needs. I assure the House there is no rationing of these products, which are provided to people as they need them. That is important when people are making telephone calls or trying to reassure families. There is no limit set out and no rationing taking place.

The HSE operates a flexible home delivery service, which currently provides incontinence wear products to more than 70,000 people. It also operates a bulk delivery system to community nursing homes and residential care settings. This is to ensure each person receives incontinence wear products as he or she needs them. The improved provision of incontinence wear products to eligible persons nationwide is rightly viewed by the HSE as one of the indications that the national service improvement programme can deliver. The reimbursement support for incontinence wear products available under the drug payment scheme ensures all persons, including those who do not have full eligibility, can avail of such products as they need them.