Seanad Éireann debate -
Tuesday, 27 Apr 2004

Vol. 176 No. 6

Hospital Services.

Mr. B. Hayes

It would be an act of medical madness for the Government to allow Peamount Hospital in west Dublin to close as a result of a major downgrading of the hospital, which is proposed by a small unaccountable group. The case of Peamount is unique because of its position as the national centre for TB eradication. It is also unique because it has a capacity of more than 350 beds at a time when the bed capacity in the major acute hospitals in Dublin represents a major problem. I cannot see how any Government would sit idly by and watch this medical facility close when it is clear that there is a need for the medical expertise currently at Peamount.

The Eastern Health Board, the Medical Council and local GPs in the area want the hospital to continue its good work. We have yet to hear from the Minister for Health and Children, who seems to be oblivious to the current crisis in Peamount. This is despite the fact that the Minister provides close to €20 million per annum from the Department's Vote for the hospital. One must ask who or what is behind this deliberate act to close Peamount Hospital. We are told the report from Comhairle na nOspidéal on the hospital, which incidentally is three years out of date, was roundly opposed by the board of the hospital over two years ago. The board wrote specifically to the Minister for Health and Children rejecting the Comhairle proposals and a second report was then commissioned. In the context of this controversy, all the interested parties now want to know what has changed so dramatically in two years.

The immediate impact of the closure of the 60-bed chest hospital at Peamount would have a knock-on effect for many of the other acute hospitals in the Dublin region. The immediate impact of closing Peamount Hospital would be to put additional pressure on the already overcrowded major hospitals in Dublin because the acute hospitals can no longer refer patients to Peamount in respect of chest-related illnesses. However, as the Minister well knows, the expertise and, most important, bed capacity would be forever lost were the hospital to close.

Will those directly involved in the management of the hospital take into consideration the 70 local general practitioners who use the hospital on an ongoing basis to speedily turn around testing and other laboratory uses for local patients? Peamount Hospital is not a stand-alone hospital facility in that it has direct links with the local community it serves. The bottom line is that it works for the local medical infrastructure in the Newcastle, Lucan and Clondalkin areas of west Dublin. It would be a crying shame to lose it.

Will the Minister of State confirm in his reply why the CEO of Peamount Hospital can now determine admissions policy without recourse to medical advice? I am not aware of another hospital in the State where this is the case. It is daft to be downgrading this TB hospital when instances of the disease are on the increase and when Dublin hospitals are already overcrowded and understaffed.

The IMO recently warned about a shortage of beds in major Dublin teaching hospitals. We saw this for ourselves when there were instances of the winter vomiting bug and we noted the acute pressure it put on bed capacity in the greater Dublin area. Letting Peamount Hospital go by the wayside would escalate the crisis in our Dublin hospitals. Will the Minister for Health and Children intervene directly in this mess? It is high time he did, not only to save the hospital but also to integrate the services it offers into the wider provision of medical services in the greater Dublin area. We cannot afford to lose the hospital, nor can we attempt to treat highly infectious TB sufferers without endangering other acutely sick patients. Peamount Hospital has a special role to play in the control of tuberculosis and in the prevention of multi-drug resistant tuberculosis. Will the Minister support the medical director in the hospital, other local general practitioners and the entire west Dublin community by allowing this hospital to retain the services it provides?

The Minister of State, who is listening attentively to the debate this evening, should note that if we lose the chest hospital it will follow, as night follows day, that we will lose the other sections of the hospital which deal with learning disabilities and the young chronic sick and which provide services for the elderly. This cannot be allowed to happen given the investment of the Minister for Health and Children in the hospital, the hospital's role in dealing with the TB epidemic in the 1940s and 1950s and its strategic role in offering beds to the acutely sick in the greater Dublin area.

Minister of State at the Department of Enterprise, Trade and Employment (Mr. Fahey)

I am delighted to have this opportunity, in the unavoidable absence on official business of my ministerial colleagues at the Department of Health and Children, to respond to the Senator on this important issue. Neither the Department of Health and Children nor the Eastern Regional Health Authority, which has responsibility for the provision of services at Peamount Hospital, is aware of any proposal to close the hospital.

The background to the future organisation and delivery of respiratory and TB services can be found in a report of a review on respiratory medicine carried out by Comhairle na nOspidéal, published in July 2000. This report found that, in line with major advances in medical treatment, the optimal in-patient care of patients with respiratory diseases, including tuberculosis, is more appropriate to local acute general hospitals, staffed by consultant respiratory physicians and other consultants and supported by an array of investigative facilities.

While recognising the valuable role Peamount Hospital had played for many years in the delivery of respiratory services, Comhairle did not regard it as an appropriate location for the future treatment of TB patients, especially those requiring ventilation and specialised treatment for other symptoms, including heart disease and HIV, who may present with tuberculosis.

Comhairle subsequently appointed a committee to advise on the implementation of the 2000 report. The report of this committee endorsed the recommendations in the 2000 report and was adopted by Comhairle in April 2003. Specifically, the committee recommended that Peamount Hospital should play an active role in the provision of a range of non-acute support services, including pulmonary rehabilitation, within the South Western Area Health Board. For example, it recommends that patients who have been treated in the nearby St. James's Hospital and other major acute hospitals, and who require ongoing rehabilitative care, could be transferred to Peamount Hospital for completion of their care.

In addition to the Comhairle advice on this issue, the board of Peamount Hospital has developed a strategic plan for the development of services at the hospital. The hospital employed external support to assist it in this process and to advise on developments in the wider health care environment. The strategy adopted by the board proposes considerable enhancement of existing services and development of new services in the areas of rehabilitation and continuing care of older people, persons with intellectual disabilities and adults with neurological or pulmonary illness.

On 22 March 2004, two of the senior medical personnel at Peamount Hospital secured interim High Court orders restraining their removal from their positions. The interim injunctions were granted to the medical director and senior medical officer. The matter arose by virtue of the termination by the hospital board of the medical director's post and revised arrangements for the senior medical officer's post arising from the new arrangements for the delivery of services at the hospital.

The hospital's policy on admissions to its TB and non-TB respiratory units has been clarified following the granting of a further interim injunction by the High Court on 31 March 2004 which stated that admissions to Peamount Hospital require hospital management approval. I understand a full hearing in the High Court was scheduled for today, 27 April 2004, but the outcome of this hearing is not yet known.

The admissions policy provides as follows. All new referrals to the hospital must first have been assessed in an acute general hospital — the recent transfer of a patient with multi-drug resistant tuberculosis to Peamount from the Mater Hospital, where he had been stabilised, is consistent with this approach; the transfer of patients from other hospitals to Peamount must be considered in the context of such patients being non-acute and on the basis of the transferring consultant being aware of the facilities and staff available at Peamount — this is in line with the recommendations of the Comhairle report regarding the future organisation and delivery of respiratory and tuberculosis services — Peamount does not have a Comhairle-approved consultant respiratory physician on its medical staff; elective scheduled admissions will be postponed until after the date set for the full High Court hearing, 27 April 2004, and rescheduled after that date — current patients with a diagnosis of malignancy will be admitted at the discretion of medical staff; and the out-patients department will continue to be maintained.

In light of this clarification of the hospital's admissions policy, a consultative process has now been initiated by the ERHA with all referring hospitals and health boards to ensure there is full awareness of Peamount Hospital's admissions policy. Within the functional area of the authority, hospitals are being asked to liaise with public health personnel regarding support requirements for patients with tuberculosis. The authority will also put in place contingency plans to manage patients locally.

Services in the Peamount Hospital, such as phlebotomy and X-ray, will continue to be available to the local community and much of the discussion to date has related to how the hospital can more effectively meet the primary care needs of the local population. After discussion with local general practitioners, it is clear that key concerns have arisen over the management of older people with chest infections and respiratory difficulties. The authority is in continuing discussion with the hospital on how these services will be maintained. This approach will be supported by the appointment of a consultant geriatrician to Tallaght and Peamount hospitals, approved by Comhairle, with two sessions per week specifically committed to Peamount. A joint consultant post in rehabilitation medicine is also being established between the National Rehabilitation Hospital and Peamount Hospital. Existing day and residential services for older people and people with intellectual and physical disabilities continue to be provided.

In conclusion, I am advised that the direction which Peamount is now taking will see it developing its overall role and its support for acute hospitals, general practitioners and the community of the surrounding area and is in line with its duty of care to patients and its commitment to the provision of the highest quality of care to existing and future patients.