Seanad Éireann debate -
Thursday, 20 May 1993

Vol. 136 No. 6

Adjournment Matters. - Ennis (Clare) General Hospital.

Mr. Daly

I thank you, a Chathaoirligh, for giving me the opportunity to raise this important matter on the Adjournment. I also thank the Minister for coming here. I am aware, from previous discussions he had with public representatives and with an important delegation he recently graciously received, that he is fully aware of the widespread concern at the diminishing level of services in the general hospital in Ennis.

The Minister is aware that there has been a constant curtailment of services and activity at the county hospital; bed numbers have been consistently reduced over the last few years. Serious hardship is being experienced by many, by those in isolated parts of the country, because of the absence of facilities in the hospital, indeed, the general maternity service has been discontinued. The most recent curtailments, including changes in staffing levels for the ambulance service, the closing down for periods and at night of the accident and emergency services and the curtailment of acute surgical services by the closure of an operating theatre are now creating serious doubts about the future viability of acute surgical services in the hospital. It is widely thought that the closure of this theatre will precipitate the final closure of acute surgical services there and that future surgical services for the area will be provided at the regional hospital in Limerick or in the adjoining regional hospitals in Galway or Tralee.

We have had widespread calls from various organisations and individuals in support of the hospital seeking to impress upon the Minister the desirability of providing additional funding to the Mid-Western Health Board, to enable it to provide the same level of services at the hospital — as a minimum — as last year. From the funding available to the health board, it is clear that unless these curtailments, which are currently being discussed with representatives of the unions involved, are agreed, the hospital may well have to close one of its main wards for the summer, with the subsequent lack of facilities for many needing acute hospital treatment. Due to lack of funds, the available services there may not even be funded to last year's level. The mixing of male and female patients in wards was vehemently opposed by many last year because it created undue hardship for the patients and caused anxiety for their relatives and visitors.

The situation in Ennis is now chronic. We welcome the financial package announced yesterday by the Minister and compliment him for getting the Government to provide an additional £20 million in funding to relieve the acute waiting lists. Could some of this funding be allocated to the general hospital in Ennis to prevent the closure of the acute operating theatre this year? Otherwise, the waiting lists will get longer and the hospital will become less viable as an acute surgical unit. The Minister has a contingency fund of about £412,000 — and an allocation from that sum would help to keep the theatres fully operational in the hospital. It would also alleviate the fears in regard to the closure of the acute surgical services unit and the further downgrading of the hospital, at a time when this service is urgently needed in County Clare.

I do not wish to delay the Minister. However, I repeat that there is a widespread belief that services in the hospital are gradually being diminished and curtailed to an extent which will lead to inevitable closure, especially of acute surgical services. This is causing widespread anxiety to the people of the country, especially to the staff and professionals who operate the services in the hospital.

I do not wish to raise any fear that might further damage the prospects of the hospital. It has been providing an excellent service within the limit of the capacity of those working there and the available financial resources. A highly professional and caring service is being provided at the general hospital in Ennis for the country and we wish it to continue. Additional staff should be appointed, a review was carried out last year which indicated that this was necessary. We also want the Minister to examine the possibility of even a limited emergency maternity service, especially for the people of the peninsula who are miles from the nearest maternity services. There is widespread anxiety and there have been tragedies because of lack of this facility.

The Minister can assist the Mid-Western Health Board now. Like most health boards it is in financial difficulties but, in the contingency funding which was announced yesterday, it may be possible to find some money which would enable the Mid-Western Health Board to keep the operating theatres and emergency services — especially the accident and emergency services — operating at the same level as last year. I again appeal to the Minister to specifically examine this case and consider what assistance he can give to help to maintain the very high level of service at Ennis General Hospital.

Minister for Health (Mr. Howlin)

I am grateful to have this opportunity to place on record the facts in relation to the future of Ennis General Hospital. Senator Daly and his Oireachtas colleagues from County Clare have, in the four months I have been in office, forcefully expressed their concern for the future of its services. It is important that the message is clear and I assure this House that the hospital will continue to play an integral part in the overall acute hospital services in the Mid-Western Health Board area.

The health board undertook a detailed examination in 1988 of the acute care services in the region and this confirmed the continued role of Ennis General Hospital in the provision of these services for the population of County Clare. The hospital's bed complement was fixed having regard to this role and there are currently 94 beds in Ennis General Hospital. This figure is made up of 52 general medical beds, 26 general surgical beds, six day care beds and ten beds in the new geriatric assessment unit. The day care beds are used for patients who undergo minor surgical procedures and return home the same day. The number of procedures which can be carried out in this way is growing and, in 1992, more than 1,300 day cases were treated in the hospital.

The fears expressed in County Clare about the future of Ennis General Hospital are without foundation. There is no agenda, hidden or otherwise, in my Department or in the Mid-Western Health Board concerning any downgrading or closure of the hospital. The Mid-Western Health Board has, over the last five years, spent £0.5 million pounds on improving and upgrading the hospital. The improvement programme has included the refurbishment of the operating theatres and the purchase of new equipment for the intensive care unit. The surgical ward and two medical wards have been upgraded and the accident and emergency and physiotherapy departments have also been enhanced.

My Department is currently in discussion with the health board about proposals for further developments in the hospital, especially in regard to an equipment replacement programme. These proposals must have regard to the limited resources available to me for capital projects and the many competing demands for funding. I will look upon these proposals as sympathetically as possible.

I referred to the dedicated geriatric assessment unit in Ennis General Hospital. This new ten-bed unit came into full operation in July 1992 and involved the appointment of a new consultant physician in geriatric medicine as well as additional support staff. The provision of this unit was in recognition of the increasing geriatric dimension to the medical workload not only in the mid-wetern region but also in other health board areas.

As regards maternity services, it is the policy of the Mid-Western Health Board that all obstetrics services in the region should operate on a centralised basis at the regional maternity hospital in Limerick. Gynaecological and antenatal care are provided at Ennis General Hospital on an out-patient basis. In line with the trend nationally, the number of births in the mid-western region has continued to fall in recent years and it is envisaged that obstetrics services should continue to be provided at the regional maternity hospital, as this is considered to be the most appropriate way of providing services for the region as a whole.

In March this year, I had a meeting in Leinster House with a deputation comprising public representatives from County Clare and many other interested parties to discuss their concerns about Ennis General Hospital. At this meeting, I undertook to have officials from my Department visit the hospital and to report to me on the situation there.

This visit was undertaken by two senior officials in recent weeks and they have reported their findings to me. Their report confirms that the hospital provides an essential and valuable service to the people of County Clare. The fabric of the hospital has been greatly improved by the programme of refurbishments already mentioned. It is recognised that there are some areas still in need of refurbishment and enhancement and the necessary measures will be considered urgently by my Department in discussion with the Mid-Western Health Board.

I would like to turn now to the issues of the funding and efficiency of Ennis General Hospital. There is no need to detail the budgetary constraints under which I, as Minister for Health, must operate. Suffice it to say that there is no scope for additional resources being allocated to the funding of existing health services, above those allowed for in this year's Estimate. It is, therefore, imperative that the health board ensures that it operates within the approved levels of allocated expenditure.

The Mid-Western Health Board allocated £5.36 million to Ennis General Hospital in 1993. To live within this amount, the hospital must function as efficiently as possible. The Mid-Western Health Board is anxious to avoid a repetition this year of the difficulties which arose in 1992.

The health board has, therefore, undertaken a detailed examination of the staffing and activities of several departments in the hospital and has compared these with staffing and practices in similar hospitals elsewhere around the country. As a result of this review the health board has identified a number of areas where there is scope for greater efficiency in the delivery of services and is at present engaged in a series of discussions with staff interests about the implementation of new arrangements in these areas of the hospital.

It must be borne in mind that activity levels in hospitals vary according to the time of year. They also vary each week and at different times of the day. The health board's aim is to ensure that staff members on duty are sufficient to meet the peak periods of demand and are scaled down when activity decreases.

The present system of deploying staff in Ennis General Hospital has, I understand, resulted in situations arising where, at times, staff are on duty in certain departments when there is very little or no activity in progress. The Mid-Western Health Board proposes to redeploy staff from those areas during periods of low activity while at the same time ensuring that all services continue to be available when required.

Provided the proposed measures are agreed by the interested parties, the health board is confident that it will be possible to avoid any ward closure in Ennis General Hospital in 1993. The health board intends to continue providing the full range of services currently available in the hospital and to do so within the approved budget. There is no question of reducing the approved staffing levels in the hospital.

In conclusion, I repeat my assurance to the people of County Clare that both the Government and the Mid-Western Health Board are fully committed to the continued provision of acute medical and surgical services at Ennis General Hospital. Furthermore, the services provided and the fabric of the hospital will be improved, as resources permit. It is a significant factor in my determination of resource allocation.