Seanad Éireann debate -
Tuesday, 19 May 2009

Vol. 195 No. 9

Hospital Services.

Senator Geraldine Feeney

I thank the Cathaoirleach for allowing me to raise this important issue and I thank the Minister for agreeing to take the Adjournment debate. The matter I want to raise relates to expectant mothers, and the case I will deal with is in the Galway area. An expectant mother cannot avail of private accommodation in a public hospital unless she has made a private contractual arrangement with a consultant obstetrician, even though she has private health insurance. I use the phrase "expectant mother" rather than "patient" because pregnancy is not an illness. Everybody will agree it is a confinement, if we want to have a term for it. It has been brought to my attention that obstetrician-gynaecologists in the Galway area, and further afield, charge a fee of between €2,000 and €3,000 to deliver a baby — it may be even more in Dublin. That must be paid by the mother although she pays her private health insurance. If she does not enter into an arrangement with the obstetrician to deliver her baby, she cannot avail of the private room.

A survey reported that 50% of expectant mothers would prefer their babies to be delivered by a midwife but avail of a private room after having their babies. This pilot scheme was carried out in Cavan and Drogheda. Some 50% of eligible women would choose a midwifery-led service rather than a consultant-led service — there is a consultant-led service in place. Similar initiatives in Cork and Dublin also demonstrated a strong demand. There is evidence in these surveys that 50% of women would prefer their babies to be delivered by a midwife rather than an obstetrician-gynaecologist.

I am familiar with the Health Act and because of its age it might be a little antiquated in that it did not allow for a public patient to have a private room. Matters have moved on and women no longer stay in hospital as long after childbirth. I know of a baby who was born in the Minister's constituency last Saturday and the mother and baby were out of hospital on Sunday. If one had a normal delivery, one would stay three days in hospital but if one had a caesarian section, one would perhaps stay five days.

An expectant mother should have a choice. She should be able to decide that she wants a midwife to deliver her baby and to avail of a private room or that she wants an obstetrician-gynaecologist to deliver her baby and to avail of a private room. It should not be one or the other. It is a bit much for consultants to demand that their services should be used in order for a woman to avail of a private room.

Minister of State at the Department of Health and Children (Deputy Barry Andrews)

I am taking this Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I take this opportunity to congratulate Councillor Cormac Devlin on the birth of his first daughter last Saturday. I believe the Senator was referring to Caoimhe Devlin.

The Health Acts 1947 to 2008 set out the framework for the provision of public acute hospital services by, and on behalf of, the Health Service Executive. The principal remit of public acute hospitals, including public maternity hospitals and units, is to provide hospital and maternity services to public patients.

Any person ordinarily resident in the State is entitled to public hospital services on the basis of full eligibility or limited eligibility. In the case of maternity services, expectant mothers are entitled to avail of free public hospital services.

The health system also enables patients to be treated in a public hospital where they opt to be the private patient of a hospital consultant. However, to protect access for public patients, the legislative framework limits the proportion of private activity which can be undertaken in public hospitals. One of the Government's central objectives in negotiating the new hospital consultants' contract was to improve access for public patients to public hospital services.

One of the mechanisms used to control private activity in public hospitals is the bed designation system which was introduced in 1991. Under this system, approximately four out of every five beds are designated for the use of public hospital patients. The percentage of beds designated as public or private varies somewhat between individual hospitals. This system allows for private patients requiring immediate admission to be accommodated in a publicly designated bed where no private bed is available.

The proportion of private work which a hospital consultant may undertake is also subject to control. The new consultant contract arrangements provide for a total prohibition on private practice for consultants holding the type A public-only contract. Type B holders may undertake private activity in their employing hospital. Type B and type C holders may undertake private activity off-site. Approximately 560 of the 1,550 consultants who have accepted the new contract have opted for the public-only contract. The new arrangements also provide for the enhanced management and strict monitoring of hospital consultants' work to ensure the permitted ratio of private activity is not exceeded.

The Minister for Health and Children is satisfied these new arrangements, with the other measures in place, will ensure greater equity of access for public patients and a proper balance between public and private activity in the public hospital system.

Where a person wishes to avail of hospital services on a private basis, this is subject to their being under the care of an admitting consultant whose contract permits private practice and to a private bed being available at the time of admission. In such circumstances, where a private bed is not available, a patient may still be admitted but will not be deemed to be a private patient in respect of hospital accommodation arrangements.

The Minister asked me to emphasise the Government's commitment to protecting an appropriate proportion of public hospital capacity for public patients. A consequence of this policy is that, although a private patient may wish to be accommodated in a private bed, it may not be possible to facilitate this in every case.

Senator Geraldine Feeney

I thank the Minister of State. I do not believe an expectant mother will be able to get a private bed in a public hospital. However, it is heartening to note that so many consultants have bought into the public contract rather than the public-private one. A private patient may not get a private bed, although a consultant who takes on an expectant mother but who is not there for the delivery and the baby is delivered by a midwife still must be paid the fee. That is a little unfair and is something at which we must look if we are ever amending legislation.

Senator Nicky McFadden

I raise this important matter because I need clarification from the Minister of State on the downgrading of services at the Midland Regional Hospital Mullingar and, indeed, at the Midland Regional Hospital Portlaoise. There is a rumour that accident and emergency services at Mullingar hospital will operate from 9 a.m. to 5 p.m. and not at weekends. While it is a rumour, there is no smoke without fire. Currently, I believe patients for CAT scanning services are being transferred from Portlaoise hospital to Naas General Hospital. Patients from Longford and the greater Westmeath area will have to travel to the Midland Regional Hospital Tullamore in County Offaly, a hospital with which the Cathaoirleach is very familiar and which provides a great service. However, it is already catering for a large area of County Offaly.

In the cutbacks announced in the budget in April, 70 nursing posts have been lost to Mullingar hospital. The Minister repeatedly said the old, vulnerable and the sick would not be affected by these cutbacks. On the Order of Business, I referred to a newspaper article on the amount of money spent paying for consultancy services which Professor Drumm, in his wisdom, has brought in. It is extraordinary that it is sick people who are being affected by these serious cutbacks and not the professionals or administrators who Professor Drumm, in his wisdom, has chosen to employ.

I acknowledge the need for centres of excellence. However, the Minister of State, coming from Dublin, might not appreciate the need we, at a regional level, have for acute hospitals. We have accepted the fact cancer services must be provided at a centre of excellence and that there must be the numbers to deliver a good service. However, I cannot stand over the downgrading of acute and accident and emergency services in Mullingar hospital. We must provide a safe and good health service for the people of the midlands. The National Health Service in the UK regrets having closed down so many of the cottage hospitals.

Since being elected, I have spoken in the Seanad on cancer services and on the failure to open a sexual assault unit in Mullingar. The HSE tried to locate the sexual assault unit in Tullamore even though there are no gynaecological or obstetric services there. I raised the issue of colposcopy services being moved to Tullamore even though there are no gynaecologic or obstetric services there. The dermatologist has not been replaced in Mullingar hospital. Staff, hospital consultants and politicians must always be on guard to ensure services are not withdrawn. This is not something with which the nurses and doctors who are trying to run an excellent service in Mullingar hospital should have to deal in their daily work.

I thank the Minister of State for taking the time to listen to me and ask him to convey my words to the Minister because I am sure the reply will not cover the issues I have raised.

Deputy Barry Andrews

I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney. The Government has shown its commitment to the Midland Regional Hospital Mullingar through a series of capital improvements in recent years. Stage one of the phase 2B capital development at Mullingar commenced in 2006 and is scheduled for completion shortly at a cost of €23 million. This phase of the project includes the fit-out of the existing ward shells to provide a new paediatric ward, a new day surgery-gynaecology ward, a new obstetric ward and a new medical ward, incorporating an acute stroke unit; refurbishment of the existing paediatric and obstetric wards to provide surgical and medical wards and a palliative care unit; and an extension of the existing facilities to accommodate an interim special care baby unit adjacent to the new paediatric ward. I am pleased that these works have been completed and the ward areas are now fully operational

In addition, approval was granted for the refurbishment of two further wards in the existing hospital, namely, medical-surgical and delivery-gynaecology wards. This work is now completed and the wards are due to be commissioned shortly. Completion of this phase of the project will see the bed complement increase from 215 to 244 and will enhance the range and level of services provided.

In terms of activity levels in the current year emergency department presentations at Mullingar regional hospital were down by 7% to the end of March 2009 on the service plan target. Emergency department admissions were up by 4% against target. The HSE advises that 89% of those admitted from the emergency department at Mullingar to date in 2009 were admitted to a ward within six hours of the decision to admit having been made and that the remainder were admitted within 12 hours. It advises that no person waited in excess of 12 hours to be admitted. This compares very favourably with the performance of some other hospitals which have noticeably longer waiting times for admission from the emergency department.

Outpatient activity was up considerably on the target for 2009, although in line with activity at the end of March 2008. However, it should be noted that the target for 2009 had been reduced substantially to promote a reduction in the volume of return visits and to facilitate an increase in the number of new patients seen. I know the hospital will continue to focus on the best possible quality of care for all its patients.

Senator Nicky McFadden

This is the reply I have received to all other points I have made in respect of every concern people in Mullingar have concerning services. Although I acknowledge what the Minister of State and the Minister for Health and Children have said about a great deal of money having been spent, I asked a very direct, straight question to clarify the situation in respect of rumours of a downgrading or closure of accident and emergency facilities during the evenings and at weekends and that was not answered. I ask the Minister of State to provide me with a better answer.

Deputy Barry Andrews

The question, as submitted, did not address that issue. The Deputy must——

Senator Nicky McFadden

Will the Cathaoirleach please read out the question?

An Cathaoirleach

"The need for the Minister for Health and Children to outline the position in respect of accident and emergency and acute services for Mullingar General Hospital."

Senator Nicky McFadden

We all know the exact position.

Deputy Barry Andrews

The issue of rumours does not really arise in the question and therefore I did not have the opportunity to address it. We can look at it in time.

Senator Nicky McFadden

A review is taking place and I assumed the Minister of State would refer to it.

An Cathaoirleach

I know the Minister of State will relay Senator McFadden's fears to the Minister for Health and Children, Deputy Mary Harney.

The third Adjournment matter is a joint one, taken together by agreement, for which I thank Senators Cummins and Coffey.

School Staffing.

Senator Maurice Cummins

I welcome the Minister of State, Deputy Andrews, to the House.

Mount Sion primary school was the first Christian Brothers school founded by Blessed Edmund Ignatius Rice and the people of Waterford and the entire country are rightly very proud of it. It has provided education for all classes and its commitment to newcomers of ethnic origin is consistent with the work undertaken by its founder.

The school has appealed against its staffing allocation which, if implemented, will have devastating effects on staff and students alike and will result in the school having to struggle to provide the type of education which we expect and deserve today. This appeal from Mount Sion is not based on history or sentimentality but on the knowledge that the school is providing a service to a group of children and their parents and guardians that enables them to make real progress. Theirs is a worthy cause and I ask the Minister of State to make the correct decision and allow this school to continue its good work with the required number of staff. This school is a beacon for education in the heart of Waterford's inner city and the proposed cuts to its staffing are unfair and unworkable.

It appears that because in the period 30 September 2008 to 28 November 2008 the school, with 346 pupils, was one pupil short of the prescribed number, it is now to lose a mainstream teacher even though from 1 December 2008 until the present its enrolment is in excess of the prescribed number, 347 pupils. The projected enrolment figure for September 2009 is 358. Some 30% of the school population is of newcomer status or ethnic origin. Given that the school also stands to lose two language support teachers, the increase in class sizes arising from the loss of a mainstream class teacher will reduce learning opportunities for those children whose first language is not English. Consequently, the extra burden of support placed on the class teacher will be to the detriment of the other children and the class.

My colleague, Senator Paudie Coffey, will outline other reasons the appeal from this school should be upheld. I ask the Minister to allow this school to continue to raise the attainment standards of its pupils. To do this it needs to maintain its full complement of staff. In the interests of fairness and equity, I ask that this school be afforded the same opportunities that pupils have in similar schools in Waterford city and I hope the Minister of State will provide a positive response to this appeal.

Senator Paudie Coffey

I thank the Minister of State for attending to hear this Adjournment matter which I am glad to share with my colleague, Senator Maurice Cummins. He has outlined the proud tradition of Mount Sion primary school in the heart of the inner city in Waterford which has provided an essential educational service for the boys of that area for many generations. The nub of the issue concerns the enrolment figures. From September to November 2008, as my colleague stated, there were 346 pupils enrolled, just one short of the prescribed number that would allow the school to retain its full complement of mainstream teachers. A month later, in December 2008, the school had in excess of 347. The enrolment figures that were returned to the Department contained one too few, but since then the figures have increased. The enrolment for 2009 is 358 pupils.

It defies logic that common sense cannot prevail on this occasion. This is an area in which we can restore faith in politics and politicians. The Minister of State, Deputy Andrews, is not the Minister for Education and Science but he has responsibility for children and young people and I know he has a deep understanding of the effect that this move to reduce the number of teachers in Mount Sion primary school will have across the range of classes, numbering more than 350 pupils. This is an occasion where politicians can make a difference and can step in and intervene with the bureaucrats. If the bureaucrats maintain that these children are to be treated according to the statistics, all of them will suffer because every class in Mount Sion primary school will have more than 30 pupils, and that is unacceptable. As Senator Cummins noted, a significant percentage of the pupils are non-national in origin. In addition, the school is disadvantaged and for that reason alone it has many pupils with special educational needs and learning difficulties. It is important, therefore, that the number of class teachers is kept at a viable level so that all pupils can receive the education they deserve.

I shall offer one example. The school turned away two families that wished to enrol their sons in sixth class for this school year. It did this on the basis that there were already 30 children in the class. If it had been known these new ratios were to be introduced the school would have enrolled the boys but because it was not, Mount Sion will lose the extra class teacher.

I appeal to the Minister of State to request the Minister for Education and Science to allow common sense to prevail, to let politics prevail over bureaucracy and statistics and allow Mount Sion school to maintain the number of teachers it has. They do a marvellous job — I cannot over-emphasise the job they do — in inner-city Waterford in a large area of disadvantage in education. I appeal to the Minister of State and am hopeful he will give me a positive response. If not, I hope, in his role as Minister of State with responsibility for children and young people, he will take the issue further with the Minister for Education and Science so that this school in inner-city Waterford will receive the support it deserves.

Deputy Barry Andrews

I take this Adjournment matter today on behalf of my colleague, the Minister for Education and Science, Deputy Batt O'Keeffe. I thank the Senators for raising this matter.

The Minister is committed to providing information on the allocation of teachers to schools and as a new feature on the Department's website. The process has begun with the provision earlier this year of initial information on the allocation of mainstream classroom teachers to primary schools under the revised schedule for 2009-10.

In terms of the position at individual primary school level, the key factor for determining the level of resources provided by the Department is the pupil enrolment at 30 September 2008. The annual process of seeking this enrolment data from schools took place in the autumn and the data have since been received and processed in the Department, enabling the commencement of the processes by which teaching resources are allocated to schools for the school year that begins next September. The Department has written to the primary schools that are projected to have a net loss or gain in classroom teaching posts in September 2009.

As part of the Minister's efforts to ensure relevant information is openly available to the public, detailed information on the opening position for primary schools is now published on the Department's website. This provisional list sets out the details on individual schools that, taken collectively, are projected to gain 128 posts and to lose 382 posts, a net reduction of 254. It is the Minister's intention to have this information updated and ultimately to set out the final position when the allocation processes are completed.

The final position for any one school will depend on a number of other factors such as additional posts for schools that are developing rapidly and posts allocated as a result of the appeals processes. The operation of redeployment arrangements also impacts on the final position as a teacher can remain in his or her existing school where a suitable redeployment position does not exist. The final staffing position for all schools will therefore not be known until the autumn. At that stage the allocation process will be fully completed for mainstream classroom teachers and appeals to the staffing appeals board will have been considered.

I understand that the school referred to by the Senators submitted an appeal to the primary staffing appeals board. The board considered the school's submissions at its meeting on 14 May 2009 and has requested additional information before making its decision. Following this process the school will be contacted with the outcome of the appeal decision. The appeal board operates independently of the Department and its decision is final. I thank the Senators again for providing me with the opportunity to address the House on this matter and to outline the current position.

Senator Maurice Cummins

I thank the Minister for replying, but again it is a Pontius Pilate act to say the appeals board is an independent body. As Senator Coffey stated, this is bureaucracy gone mad. The figures are there to support the appeal and, while I expect that when the appeals board gets the further information it requires it will uphold this appeal, it is unfortunate the Minister could not come in and say Mount Sion is to maintain the same staffing level it had last year in view of the information that has been put before the appeals board. I am disappointed in that regard but I hope that when the appeals board gets the further information, this will be a fait accompli and Mount Sion will get back its additional teachers.

Senator Paudie Coffey

I, too, thank the Minister of State for his response. However, we see the Government every day handing over important decisions such as this to independent bodies, whether they be the HSE, the National Roads Authority or whatever. At times, it is a requirement to be independent, but I ask the Minister of State to take into account the fact that these are real children, not statistics. Bureaucracy sometimes can overcome the common sense that should prevail in our communities. I am sure Mount Sion primary school has already made a very good appeal with all the information the appeals board requires. I ask the Minister of State, however, to take notice of that appeal and watch the outcome. I am very hopeful the appeals board will make the right decision based on the information submitted and on the case Senator Cummins and I have made in the Seanad.

If this appeal outcome is negative in any way, both of us will be back in all our powers to revisit this subject because an appeals board should not be overly bureaucratic. This is where we can restore faith in politics. The real facts should mean something. We have presented some of them today, the Mount Sion board of management will present the full picture to the appeals board and I hope that, based on its merits, the school will retain its full complement of teachers. If it does not, only the pupils of that disadvantaged area will suffer. That is not something I can stand over and I shall revisit the matter if that happens.

The Seanad adjourned at 6.15 p.m. until 10.30 a.m. on Wednesday, 20 May 2009.